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Author manuscript; available in PMC: 2026 Apr 15. Published in final edited form as: J Psychosoc Nurs Ment Health Serv. 2023 Jul 3;62(1):27–35. doi: 10.3928/02793695-20230622-01 Search in PMC Search in PubMed View in NLM Catalog Add to search Creating Space for Adolescents and Families With Lived Experience of Homelessness to Build Familial Empathy, Communication, and Emotional Regulation: A Qualitative Study of Facilitators of Implementation Dawn T Bounds Dawn T Bounds , PhD, PMHNP-BC, FAAN 1 Sue & Bill Gross School of Nursing, University of California Irvine, Irvine Find articles by Dawn T Bounds 1 , Sarah M Rodrigues Sarah M Rodrigues , PhD, RN 2 Sue & Bill Gross School of Nursing, University of California Irvine, Irvine Find articles by Sarah M Rodrigues 2 , Donna Balsam Donna Balsam , PhD, RN 3 San Diego State University, San Diego Find articles by Donna Balsam 3 , Nia Lennan Nia Lennan , BA 4 University of Chicago and Community and Behavioral Health Section, Chicago, Illinois. Find articles by Nia Lennan 4 , Karen Reyes Rodriguez Karen Reyes Rodriguez , BA 5 Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois. Find articles by Karen Reyes Rodriguez 5 , Norweeta G Milburn Norweeta G Milburn , PhD 6 Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles Semel Institute Center for Community Health, and the Nathanson Family Resilience Center, University of California Los Angeles, Los Angeles, California Find articles by Norweeta G Milburn 6 Author information Article notes Copyright and License information 1 Sue & Bill Gross School of Nursing, University of California Irvine, Irvine 2 Sue & Bill Gross School of Nursing, University of California Irvine, Irvine 3 San Diego State University, San Diego 4 University of Chicago and Community and Behavioral Health Section, Chicago, Illinois. 5 Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois. 6 Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles Semel Institute Center for Community Health, and the Nathanson Family Resilience Center, University of California Los Angeles, Los Angeles, California ✉ Address correspondence to Dawn T. Bounds, PhD, PMHNP-BC, FAAN, Sue & Bill Gross School of Nursing, University of California Irvine, 854 Health Sciences Road, Irvine, CA 92697; [email protected] . Issue date 2024 Jan. PMC Copyright notice PMCID: PMC13078363 NIHMSID: NIHMS2156969 PMID: 37379121 The publisher's version of this article is available at J Psychosoc Nurs Ment Health Serv Abstract Youth experiencing homelessness are vulnerable to commercial sexual exploitation (CSE). Structural racism disproportionately entraps marginalized youth into CSE while simultaneously obscuring their identification as victims. Adaptation and tailoring of effective interventions to mitigate associated sequelae and inequities is warranted. Support To Reunite, Involve, and Value Each Other (STRIVE) is a strengths-based dyadic intervention with demonstrated efficacy in reducing delinquency, substance use, and high-risk sexual behaviors among marginalized adolescents experiencing homelessness. The adapted STRIVE+ was piloted to explore potential for reducing youth risk factors for CSE. The current article reports findings from interviews exploring participants’ experiences with STRIVE+. Youth and caregivers reported increased empathy, communication, and emotional regulation post-STRIVE+ and found relevance and meaning through participating in the adapted intervention. Feasibility of recruitment, engagement, and retention of minoritized adolescents and their caregivers were also demonstrated. Findings warrant larger scale implementation trials of STRIVE+ among minoritized youth at highest risk for CSE. Minoritized adolescents (aged 13 to 17 years) and young adults (aged 18 to 25 years), collectively referred to as youth in the current article, are at disproportionately high risk for experiencing homelessness in the United States ( Morton et al., 2018 ). These statistics reflect larger systemic issues and disparities rooted in navigating multiple and intersecting forms of marginalization, including structural racism. Experiencing homelessness during adolescence adversely impacts health and development ( Gultekin et al., 2020 ) and increases risk behaviors and vulnerability to commercial sexual exploitation (CSE) ( Middleton et al., 2018 ). CSE refers to any exchange of a sexual act by a minor for anything of value, including but not limited to forced and/or transactional (or “survival”) sex ( National Research Council, 2013 ; Trafficking Victims Protection Act, 2000). Racial/ethnic, gender, and/or sexually minoritized youth experiencing homelessness are at heightened risk for CSE, including engaging in transactional sex to meet their basic needs ( Ducak et al., 2022 ). CSE places minoritized youth at increased risk for adverse health outcomes, such as posttraumatic stress, substance use disorders, and sexually transmitted infections, including HIV ( Franchino-Olsen, 2021 ; Prince et al., 2022 ). Structural racism disproportionately entraps marginalized youth of color into CSE while also obscuring their identification and recognition as victims of CSE, thereby propagating the aforementioned health disparities ( Ducak et al., 2022 ). Critically, insecure family attachments, lack of a safe home environment, and/or dysfunctional family environments have been shown to increase youth vulnerability to CSE ( Sanchez & Pacquiao, 2018 ). CSE survivors have identified interpersonal relationships, particularly with caregivers, family members, and trusted adults, as key factors to promoting risk for or providing protection from CSE ( O’Brien, 2018 ), and youth experiencing homelessness who have a supportive adult in their life have lower odds of being trafficked ( Chisolm-Straker et al., 2018 ). Adaptation and tailoring of existing effective interventions holds potential for mitigating inequities and associated adverse sequelae among youth navigating multiple and intersecting forms of marginalization, including homelessness ( Pina et al., 2019 ). Support to Reunite, Involve, and Value Each Other (STRIVE) is a strengths-based, dyadic, manualized intervention ( Milburn et al., 2012 ), which targets family functioning. STRIVE includes five 90- to 120-minute psychoeducational sessions delivered weekly by a trained facilitator. Each session focuses on reinforcing a positive family atmosphere, improving communication skills, and problem solving using cognitive-behavioral therapy principles. STRIVE has demonstrated efficacy in reducing delinquency, substance use, and high-risk sexual behaviors among adolescents experiencing homelessness within the past 6 months and was identified in a review of literature addressing social and mental health needs among transition-age youth experiencing homelessness ( Winiarski et al., 2021 ) as one of six clinically effective family-based interventions supported by randomized controlled trial data. As minoritized youth experiencing homelessness are at heightened vulnerability for CSE ( Middleton et al., 2018 ), STRIVE was adapted to explore whether “STRIVE+” might additionally reduce youth risk factors for CSE ( Bounds et al., 2020 ). Risk for CSE was measured using a modified version of the Trafficking Victim Identification Tool–Short Version ( Chisolm-Straker et al., 2021 ; Simich et al., 2014 ) and CSE was measured using the Polaris Projects’ (2011) Comprehensive Trafficking Assessment. Handouts on CSE (e.g., risk factors for youth, guides for parents) and healthy relationships (e.g., consent, boundary setting, communication) were added to each session to review as homework. By targeting family functioning and expanding psychoeducational content to address CSE, STRIVE+ holds potential to disrupt the trajectory of running away and/or parents kicking youth out of the home to reduce youth risk for homelessness and associated CSE ( Bounds et al., 2020 ). PURPOSE STRIVE+ was adapted from STRIVE to address CSE among youth experiencing homelessness in an urban setting where Black youth were disproportionately impacted by homelessness (see Bounds et al., 2020 for details). Educational content regarding CSE and healthy relationships was added to the original STRIVE intervention (i.e., five psychoeducational sessions with youth–caregiver dyads; see Milburn et al., 2012 for details). Quantitative findings assessing STRIVE+’s impact on youth risk factors for CSE will be reported elsewhere. The purpose of the current study was to better understand facilitators of implementation by exploring participants’ experiences with the STRIVE+ intervention via qualitative analysis of participant interviews postintervention. Findings may inform larger scale implementation trials of STRIVE+ among minoritized youth at highest risk for CSE. METHOD The STRIVE+ intervention was piloted with seven dyads in an urban Midwestern academic medical center setting ( Table 1 ). Dyads, composed of youth aged 13 to 17 years with lived experience of homelessness in the past 6 months and their self-identified trusted adult, were recruited in 2019, prior to the onset of the coronavirus disease 2019 (COVID-19) pandemic, to participate in testing the feasibility of STRIVE+. Unfortunately, recruitment of additional dyads was halted due to the onset of the COVID-19 pandemic in early 2020. Lived experience of homelessness was broadly defined as being without a safe and stable home, needing to live in a shelter, contact with the juvenile justice or child welfare system, and being away from home without permission due to running away and/or being asked to leave at least once overnight. Adolescents were referred for participation in STRIVE+ by homeless shelters, school counselors, or caseworkers. School counselors and caseworkers were provided study flyers with inclusion/exclusion criteria for the study and were encouraged to refer adolescents who may benefit from a dyadic intervention focused on improving family functioning. A referral-based strategy was used based on our adaptation of STRIVE described elsewhere ( Bounds et al., 2020 ). Twelve to 17 months following the STRIVE+ intervention (9 to 14 months following their last data collection point at 3 months postintervention), all participants were invited to participate in semi-structured interviews about their experiences with STRIVE+ to better understand facilitators to implementation. Facilitators to implementation were conceptualized as feasibility (ability to deliver STRIVE+), acceptability (relevance of STRIVE+ to participants, including attitudes toward and willingness to participate in the intervention), meaningfulness (participants’ affective experience participating in STRIVE+), and effectiveness (achievement of STRIVE+’s intended effects and consideration of relationships noted among effects) ( Glasgow et al., 2019 ; Sekhon et al., 2017 ; Troy et al., 2018 ). TABLE 1. STRIVE+ PILOT PARTICIPANT DEMOGRAPHICS Characteristic n (%) Adolescents Trusted Adults Age (years) 15 1 (14.3) 16 1 (14.3) 17 5 (71.4) 30 to 39 3 (42.9) 40 to 49 2 (28.6) 50 to 59 2 (28.6) Sex Female 5 (71.4) 7 (100) Male 2 (28.6) Sexual orientation Straight/heterosexual 6 (85.7) 7 (100) Don’t know 1 (14.3) Ethnicity Hispanic, Latino, or Spanish origin 4 (57.1) 3 (42.9) Not of Hispanic, Latino, or Spanish origin 3 (42.9) 4 (57.1) Race Black/African American 5 (71.4) 4 (57.1) More than one race 2 (28.6) 1 (14.3) Unknown/not reported 2 (28.6) Educational level Less than high school 6 (85.7) 3 (42.9) High school/GED 1 (14.3) 1 (14.3) Some college or Associate degree 2 (28.6) College graduate or Bachelor’s degree 1 (14.3) Employment status Employed 3 (42.9) 4 (57.1) Unemployed 4 (57.1) 3 (42.9) Open in a new tab Note. STRIVE = Support to Reunite, Involve, and Value Each Other; GED = General Educational Development. Study Design A qualitative descriptive design ( Sandelowski, 2000 ) using qualitative content analysis ( Schreier, 2012 ) was used to analyze interview data. Sample and Setting Twelve to 17 months following the STRIVE+ intervention, all 14 participants (seven adolescents, six parents, and one grandparent) were invited to participate in one-on-one semi-structured interviews via phone or Zoom videoconference. All adult participants were legal guardians and primary caregivers to adolescent participants and will herein be referred to collectively as parents. All participants were from minoritized backgrounds. Procedures and Data Collection Institutional Review Board approval (#18021703) was obtained prior to conducting this study. STRIVE+ participants were contacted to assess interest in participation and informed consent was obtained via eConsent through REDCap ( Harris et al., 2009 ). Using a semi-structured interview guide ( Table 2 ), interviews were conducted by a research assistant from an underrepresented minoritized background matching study participants. Interviews were digitally recorded and transcribed using a HIPAA–compliant language services agency with whom a confidentiality agreement was established. All digital recordings and transcripts were reviewed by the first author (D.T.B.). TABLE 2. STRIVE+ SEMI-STRUCTURED INTERVIEW GUIDE Topic Example Questions Updates since STRIVE Since you attended STRIVE, (1) What’s been working well in your family? (2) What still needs to be improved in your family? (3) What tools/strategies are you still using that you learned in or that were helpful during STRIVE? (4) What tools/strategies did you learn in STRIVE that haven’t been helpful? Thinking back to when you attended STRIVE (1) After STRIVE what areas did [you/your child] improve in? For example: (a) communication; (b) problem solving; (c) creating a positive atmosphere. (2) If applicable, ask about: (a) risky behavior/behavior problems; (b) mental health problems (depression, anxiety, posttraumatic stress disorder); (c) smoking or alcohol use. (3) What STRIVE areas did [you/your child] continue to struggle in? Engagement (1) How has [your/your parent’s] involvement in [your child’s/your] life changed? MORE/LESS INVOLVEMENT? ASK FOR EXAMPLES. (2) How, if at all, did STRIVE impact [your/your parent’s] involvement? ASK FOR EXAMPLES. Sex trafficking and sexual exploitation (1) What did you learn from STRIVE? (2) Did you learn anything about the risks of sex trafficking or sexual exploitation? What did you learn? ASK FOR EXAMPLES. (3) What about healthy relationships? What did you learn? ASK FOR EXAMPLES. Closing (1) Who do you think would benefit most from STRIVE? In other words, if you could refer someone you knew to STRIVE, who would it be and why? (2) Is there anything else you would like to share with us to help us improve STRIVE? Open in a new tab Note. STRIVE = Support to Reunite, Involve, and Value Each Other. Data Analysis Qualitative content analysis was used to analyze interviews ( Downe-Wamboldt, 1992 ; Schreier, 2012 ). Transcripts were uploaded into Dedoose version 9.0 and four coders (S.M.R., D.B., N.L., K.R.R.) were used. A coding frame was established through open coding of an initial youth and caregiver transcript by all four coders. The lead author and the four coders met throughout the coding process to discuss initial codes, merge/collapse duplicative codes, and confirm final codes. Once the final coding frame was established, two coders (D.B., K.R.R.) for adolescent interviews and two coders (S.M.R., N.L.) for caregiver interviews coded the remaining transcripts. Once the coding was finalized, the lead author facilitated meetings to complete data analysis. Emergent themes based on the resultant codes were explored in detail, and similarities, differences, and defining characteristics were identified. Major themes and subthemes reflected patterns in meaning identified by participants. Credibility was ensured by establishing and following a systematic approach to data analysis, using participants’ own words as codes, themes, and subthemes; using multiple coders to analyze the data; and by having regular group meetings to clarify definitions of codes and to interpret the data. Dependability was established by assessing the stability of the data across time points in ongoing discussions among coders and the first author over time. Confirmability (i.e., neutrality) was established through the first author, who did not code data but was able to trace the data analysis process of the coders ( Downe-Wamboldt, 1992 ; Kyngäs et al., 2020 ). Finally, transferability was established by inviting all participants to be interviewed, thereby promoting maximal diversity of participants’ perspectives within the data. RESULTS A total of 11 (79%) participants were interviewed (six adolescents, four parents, and one grandparent). One dyad was unable to be reached and one parent declined to participate. STRIVE+ themes and subthemes are presented in Figure 1 . Figure 1. Open in a new tab STRIVE+ themes and subthemes. Note. STRIVE = Support to Reunite, Involve, and Value Each Other. The STRIVE+ Space Participants repeatedly referred to a specific space created during the STRIVE+ intervention, which we have conceptualized as the STRIVE+ Space. Participants described this space as a “safe zone” providing opportunity for adolescents and parents to open up and be vulnerable together within a secure and nonjudgmental environment. Initially, the STRIVE+ Space was a physical space, created in person during each STRIVE+ session. However, this space could be created and facilitated in other spaces, such as in participants’ homes or online during a virtual STRIVE+ session. Notably, although this safe space was initially experienced through the physical environment of the STRIVE+ sessions, participants also described an ongoing embodied STRIVE+ Space that persisted beyond the length of the intervention. Thus, the “safe space” participants referred to had more to do with STRIVE+’s creation of a nonjudgmental environment than with features of the physical space where sessions were held. For example, one adolescent described STRIVE+ sessions as: [a] safe zone...a place where I could set my thoughts out on the table and where my parent could set their thoughts out on the table, and I could hear where they’re comin’ from and they could hear where I’m comin’ from in a safe environment. One parent described the importance of being listened to without judgment: I was able to literally, actually, come out and talk about my problems with somebody without bein’ judged, or laughed at...show feelings and emotions and just get a lot of things off my chest. Adolescents similarly emphasized the value of feeling listened to and of not feeling judged within the STRIVE+ Space. One adolescent highlighted the session facilitator’s nonjudgmental approach as key to understanding individual dyadic relationships: I liked that the people there were nonjudgmental. They really tried to help. They took time out to conduct surveys to get a better understandin’ of what we feel. They were studying the relationship that me and my mom had to try to offer us better solutions to our problems each and every time. That’s what I like ‘cause they actually took their time to understand our issue and try to find things to resolve instead of just trying to therapist their way into a situation that they didn’t really know much about. That’s what I love about ‘em. The nonjudgmental nature of the STRIVE+ Space provided participants with a safe zone and created opportunity for increased empathy, communication, and emotional regulation, as described below. Increased Empathy via Greater Perspective Taking and Attunement Empathy is a multifaceted construct comprised of affective and cognitive components, including perspective taking ( Stellar & Duong, 2023 ). Perspective taking (i.e., identifying and understanding others’ emotions) is related to parent–child attunement ( Di Renzo et al., 2020 ), wherein the parent attempts to understand and respond to their child’s internal state ( Holigrocki et al., 1999 ). STRIVE+ participants described increased perspective taking, which subsequently led to greater attunement, increased connection, and empathy. Perspective Taking . Youth and parent participants described STRIVE+ sessions as a gateway to understanding what each other was thinking, which led to increased perspective taking. One adolescent described how increased perspective taking led to greater self-restraint: STRIVE+ has really taught me to become more responsible and respectful of how my mom struggled and just to pull through and not necessarily do so quickly ‘cause normally my behavior was terrible. I didn’t really think. I would just do. Attunement . Attuned parents demonstrate a greater understanding of their children’s abilities, activities, and internal state ( Miller et al., 2018 ). As noted by both members of the dyad, increased perspective taking by parents led to greater attunement with their adolescent. One youth shared how her mother’s actions changed through participating in STRIVE+: …STRIVE+ taught [my mom] how to be more open-minded and how to listen more…. Like, when we argue, instead of kickin’ me out, that bein’ her first decision, she’ll try to talk it out with me, and then she’ll apologize. STRIVE+ participants expressed increased empathy through greater perspective taking and attunement which, in turn, positively influenced their communication and ultimately their relationship. Improvements in Communication Participants noted improvements in communication as one of the greatest observable effects of STRIVE+. The nonjudgmental nature of the STRIVE+ Space and the problem-solving strategies taught during the psychoeducational sessions allowed adolescents and parents to create healthier communication styles. Four subthemes emerged highlighting ways improved communication developed: Self-Reflection , Opening Up , Systematic Approach to Communication , and Less Yelling . Self-Reflection. The development of self-reflection was described as being beneficial not only for improved family dynamics, but also for coping with problems in healthier ways. According to one youth, STRIVE+ taught her how to take “a step back” to address her feelings before acting on them: “I just basically learned to take a step back in what I be doing and see if it’s anything that I could change to better that situation.” Through increased self-reflection, dyads described being better able to understand their feelings, which resulted in more effective communication during conflict. Opening Up. Participants described increased motivation for opening up with each other. Youth expressed increased confidence resulting from sharing their thoughts with their parents, a sentiment echoed by their parents. Participants described how conversations that began in STRIVE+ continued outside of the sessions, cultivating ongoing healthy dialogue between dyads moving forward. As one parent elaborated, STRIVE+ helped curate conversation with her child: “I actually got to talk to her one-on-one going to and from the STRIVE+ meetings and during the STRIVE+ meetings.” STRIVE+’s ability to build deeper ongoing connections between adolescents and their parents holds promise for creating lasting positive change within families. Systematic Approach to Communication. Along with greater self-reflection and openness facilitated by STRIVE+, participants expressed how exercises taught during sessions helped them develop a more systematic approach to communication. When asked to elaborate on experiences of improved communication, several participants referred to study handouts and being taught to write their feelings down before talking. When asked what had been working well in her family since participating in STRIVE+, one youth explained how session resources continued to be beneficial: I think it works a lot better because it’s step-by-step, and so, I think it’s more of a calming way to approach my parent or my mother when it comes to this particular plan because it’s not – we’re not speaking out of irrationality. It’s more rational when you have everything planned out. It’s almost kind of like you have an outline for an essay. Another adolescent reflected: “Me and my mom, we actually still do the little activities.” The ongoing use of communication strategies postintervention seems instrumental in maintaining healthier communications skills. Less Yelling. Participants described “less yelling” resulting from learning how to approach situations from a calmer state, particularly learning to substitute yelling with time apart, cooling down, and processing their thoughts. As one mother described: …Giving us the tools, basically, to communicate better, is the foundation for everything. Without communication, you can’t move past anything. Teaching us how to communicate with each other…. It’s learning how not just to talk but to listen. Emotional Regulation Emotional regulation is the ability to identify, understand, and manage one’s emotions ( Baumgartner et al., 2019 ; Huggins et al., 2020 ). A strong positive association has been found between emotional regulation difficulties and negative psychological sequelae among youth exposed to trauma ( Villalta et al., 2018 ). Emotional regulation emerged as a major theme, specifically via identifying and acknowledging feelings, and then learning to express or act on those feelings in healthier ways. Three subthemes emerged highlighting elements of emotional regulation: Stepping Back , Self-Awareness , and Building Ownership and Accountability to Identify Future Areas for Development . Stepping Back. STRIVE+ participants expressed improvement in not automatically reacting to a situation. In place of reacting with accustomed responses (e.g., yelling, running away), STRIVE+ participants described learning to pause or “step back,” enabling time to create distance from the event before reacting. As one parent reflected, “I’ve been able to step myself back and just really, really think about what I’m going to say before I say it and not act right away. I usually leave it for a day or two.” One adolescent shared: “I noticed when I step back from the situation first, more than just try to talk about the situation at that moment, that I’m more calm and more open-minded.” Critically, STRIVE+ families had a history of adolescents either running away, or being kicked out of the home. “Stepping back” provided a healthier strategy for handling conflict and an alternative to family disruptions due to running away from or being kicked out of the home. Self-Awareness. Self-awareness , or the understanding of one’s own emotions, thoughts, and actions, is a key antecedent contributing to emotional resilience ( Pahwa & Khan, 2022 ). STRIVE+ participants described increased self-awareness through learning the importance of validating their feelings and experiences, and described how managing their emotions was essential for relationship management and self-care. As one parent noted, “I can’t take care of nobody if I was not able to take care of myself.” As a result of increased self-awareness, STRIVE+ participants noted improved coping abilities (i.e., behaviors and thoughts that are mobilized to manage internal and external stressors) ( Folkman & Moskowitz, 2004 ). As one adolescent described, “That was something that I learned from STRIVE+. Basically, just listening and learning how to cope with my feelings in the right way.” Building Ownership and Accountability to Identify Future Areas for Development. Ownership (i.e., the process of taking initiative to understand and recognize one’s role in a situation) and accountability (i.e., taking responsibility for one’s role in a given situation) are integral to building healthy relationships. STRIVE+ participants described improvements in ownership and accountability, in addition to the need for continued work in these areas moving forward. Participants expressed recognition that healthy relationships do not just happen and described increased awareness of the importance of making time to be together, whether in person or talking on the phone. One adolescent noted more effort spending time together: “I guess the sitting down part, like really making the time; we’ll go out to eat for lunch or dinner.” Another adolescent noticed improved commitment on the part of their parent: “I think she’s more involved…she wants to be more involved.” DISCUSSION STRIVE+ was adapted from STRIVE to reduce risk of CSE among minoritized youth experiencing homelessness. Qualitative interviews were conducted to better understand facilitators of implementation by exploring participants’ experiences, with a particular focus on feasibility, acceptability, meaningfulness, and effectiveness of the STRIVE+ intervention among vulnerable youth and their caregivers. Feasibility of recruiting, engaging, and retaining diverse participants from marginalized populations, such as minoritized youth with lived experience of homelessness, can be fraught with challenges ( Curry et al., 2021 ). That this implementation study demonstrated feasibility for recruitment, engagement, and retention of adolescents from minoritized and marginalized backgrounds and their caregivers holds promise for scaling STRIVE+ to reach more families. Acceptability, meaningfulness, and effectiveness of the STRIVE+ intervention were explored through interviews, which revealed that adolescents and parents referred to a specific space created during, and persisting after, the STRIVE+ intervention. Participants described how the nonjudgmental nature of the STRIVE+ Space was key to establishing a safe zone and allowing for vulnerability and how this, in turn, created opportunity for increased empathy, communication, and emotional regulation. We posit that the nonjudgmental nature of the STRIVE+ Space, in concert with the problem-solving strategies discussed during the psychoeducational sessions, allowed adolescents and parents to create healthier communication styles. At 12 to 17 months following the intervention, dyads described improved listening and attention to each other’s emotions, as well as continuing to cultivate healthy dialogue and forge closer connections. By adopting a more systematic approach to communication through ongoing use of exercises taught during STRIVE+ sessions, adolescents and parents described improvements in communication, most notably “less yelling.” The STRIVE+ Space also promoted improved emotional regulation. Participants expressed increased self-awareness and a greater ability to understand their own emotions as well as the impact of these emotions on the dyadic relationship. This recognition led to greater ownership and accountability, including awareness of the need for continued work in these areas. STRIVE+ adolescents had a history of either running away or being kicked out of the home, and “stepping back” within the safety of the STRIVE+ Space provided an adaptive and healthier response to family conflict. The major themes and subthemes identified reflect that participants found relevance (i.e., acceptability) and meaning (i.e., meaningfulness) through participating in STRIVE+, and suggest the adapted intervention was effective in achieving its intended effects. STRIVE and subsequently STRIVE+ were designed to reduce conflict, clarify roles, teach problem solving, and improve emotional regulation. Study findings align with these goals, suggesting that STRIVE+ holds promise for families who are historically and systematically marginalized. Ideally, interventions should demonstrate efficaciousness and effectiveness before being implemented broadly ( Bowen et al., 2009 ), and study findings support the feasibility of scaling STRIVE+ through larger implementation studies with high-risk youth and their parents. LIMITATIONS There are a few limitations that should be considered while interpreting the findings of the current study. First, there was an extended period between the intervention and follow up. Although findings are thus limited to what participants remembered about their experiences with the intervention 12 to 17 months prior, the ability to garner participation with such a vulnerable population more than 1 year later may also be seen as a strength of the intervention. That participants described continuing to use and benefit from STRIVE+ tools 12 to 17 months postintervention would seem a testament to the intervention’s strength. Despite being able to identify useful skills learned, adolescents and adults reflected that more sessions during the intervention would have helped reinforce and practice the new skills they learned. In addition, although participants described continuing benefits at 12 to 17 months postintervention, adding one to two “booster” sessions to future implementation of STRIVE+ may further improve participant outcomes. Second, we used a small sample of adolescents and their parents as participants. This small sample size of interested adolescents and parents may have introduced selection bias and makes generalizability of findings difficult. However, this study’s focus on the experiences of adolescents and their parents provides diversity in terms of participant experience and perspective. Finally, although it is possible that those who elected to participate in the STRIVE+ intervention and complete the follow-up interviews may have been more likely to report a positive experience, we attempted to mitigate risk for response bias by having an interviewer who was not involved with the initial STRIVE+ data collection and intervention conduct the interviews. CLINICAL IMPLICATIONS FOR PSYCHOSOCIAL NURSING AND MENTAL HEALTH SERVICES Findings of the current study demonstrate the value of participant feedback in refining community-based interventions to thwart multiple and intersecting public health risks that disproportionately impact minoritized and marginalized youth, such as homelessness and vulnerability to CSE. The study’s modest but in-depth qualitative findings provide valuable feedback to aid psychiatric–mental health nurses working with vulnerable marginalized youth and their families, and underscore the importance of reducing family conflict by enhancing communication, problem solving, and emotional regulation skills within safe spaces. Family conflict is a primary reason adolescents run away from home, and homelessness is a primary risk factor for CSE and negative health outcomes ( National Research Council, 2013 ). Nurses are uniquely poised to identify family conflict and recommend, implement, and evaluate programs to improve family functioning for adolescents with socially complex needs in a variety of settings (e.g., inpatient and outpatient psychiatry, schools, juvenile detention centers). CONCLUSION STRIVE+’s facilitation of improved family functioning as described by STRIVE+ participants underscores STRIVE+’s aim to reduce youth risk for homelessness and CSE. The overlapping and intersecting risks associated with family conflict, homelessness, and risk for CSE warrant efforts to support minoritized adolescents and their parents in developing healthier communication, problem solving, and emotion regulation skills by scaling family-based interventions with demonstrated efficacy, such as STRIVE+. Acknowledgment: At the time of the study, Dr. Bounds was a Scholar with the HIV/AIDS, Substance Abuse, and Trauma Training Program (HA-STTP), under the mentorship of Dr. Milburn (Co-PI of HA-STTP), University of California Los Angeles. The authors thank the STRIVE+ participants for their valuable contributions of time and for sharing their experiences. The authors also thank Maruko Myint, Luis Moreal-Duarte, Julissa Hernandez, and Nayeli Inzunza for their assistance with data analysis, and Eva Balsam for her assistance with preparation of this manuscript. Funding: This study was supported through an award from the National Institute on Drug Abuse (R25DA035692) and by the Cohn Family Foundation & National Center for Advancing Translational Sciences of the National Institutes of Health (NIH) through Grant Number 5KL2TR002387–02, which funds the Institute for Translational Medicine. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Footnotes Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise. Contributor Information Dawn T. Bounds, Sue & Bill Gross School of Nursing, University of California Irvine, Irvine. Sarah M. Rodrigues, Sue & Bill Gross School of Nursing, University of California Irvine, Irvine. Donna Balsam, San Diego State University, San Diego. Nia Lennan, University of Chicago and Community and Behavioral Health Section, Chicago, Illinois.. Karen Reyes Rodriguez, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois.. Norweeta G. Milburn, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles Semel Institute Center for Community Health, and the Nathanson Family Resilience Center, University of California Los Angeles, Los Angeles, California. 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