Homeless Adolescents

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Homeless Adolescents

• A Clinical Approach to At Risk Kids

Edward Bonin, FNP Director, The Drop-In
Center Pediatric Section of Adolescent
Medicine Tulane University Health Sciences Center
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Common Myths Homeless Teens

• Smelly
• Tattered
• Unkempt

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Common Myths Homeless Teens
School Drop-Outs
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Common Myths Homeless Teens
Runaways
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Common Myths Homeless Teens
Unsheltered
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Definition of Homelessness

• Stewart B. McKinney Act, 42 USC 11301,st seq.
  (1994)
• A person who lacks a fixed, regular, and
  adequate night-time residence and has a primary
  night time residency that is
• A supervised publicly or privately operated
  shelter designed to provide temporary living
  accommodations

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Definition of Homelessness

• An institution that provides a temporary
  residence for individuals intended to be
  institutionalized
• A public or private place not designed for, or
  ordinarily used as, a regular sleeping
  accommodation for human beings.
• The tem homeless individual does not include
  any individual imprisoned or otherwise detained
  pursuant to an Act of Congress or a state law

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Who are the Homeless?
U. S. Conference of Mayors. A Status Report on
Hunger and Homelessness in Americas Cities A 27
city survey. December 2001.
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Who are the Homeless?

• AGE
• 0-12 57,430 10.5
• 13-19 31,131 5.7
• 20-44 290,378 53.3
• 45-64 152,468 28.0
• 65-84 12,793 2.3
• 85 824 .2
• Total 545,024 100

2002 Uniform Data System
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Where are the Homeless?
U.S. Conference of Mayors. A Status Report on
Hunger and Homelessness in Americas Cities A 27
city survey. December 2001.
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Homeless Children and Families

• Families with children are among the fastest
  growing segments of people experiencing
  homelessness.
• 1.35 million children per year
• 2 of children in the U.S.

Urban Institute, 2000
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Homeless Youth

• 730,000 to 1.3 million nationally
• 25 Permanently homeless
• 50 Runaway secondary to abuse
• 75 Engage in illegal activity
• 50 Involved with survival sex
• 50 Use alcohol
• 80 Use street drugs
• 35 Are intravenous drug injectors

Noell J. et al. Childhood sexual abuse,
adolescent sexual coercion and sexually transmitte
d infection acquisition among homeless female
adolescents Child Abuse And Neglect 25(1)
137-48, Jan 2001.
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Homeless Youth Gender

• While most adult homeless persons are males,
  there is a more even split among homeless youth
  52.5 are male and 47.5 are female.
• There is a power differential between male and
  female homeless youth female youth report more
  frequently resorting to survival practices
• squat hopping or sleeping with males in
  exchange for protection
• sex work
• The longer a youth is on the streets the more
  likely they are to engage in survival sex and
  other high-risk behaviors (54 of Drop-In Youth).

GENDER
SEXUAL ORIENTATION
MALE 52.5
FEMALE 47.5
Drop-In Center Supportive Services Data
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Homeless Youth Sexual Orientation

• The majority of homeless youth self-identify as
  heterosexual (71), however, many homeless youth
  report sexual experimentation with the same sex.
• GLBT and MSM homeless youth are sometimes
  referred to as throwaways because they have
  been discarded or put out by family.
• MSM homeless youth self-report higher rates of
  violence and hate crimes targeting them than
  their housed-counterparts.

SEXUAL ORIENTATION
Drop-In Center Supportive Services Data
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Homeless Youth Injection Drug Use

• Fifteen percent of Drop-In Center clients (n
  120) self-identified as injecting drugs in the
  last 3 months
• National trends suggest that there are 3 times as
  many male IDUs as female IDUs at the Drop-In
  Center more than half of current injection drug
  users are female.
• Based on focus groups conducted at the Drop-In
  Center, most female injectors are initiated into
  injection drug use by male partners and do not
  know how to shoot up by themselves.
• Source Drop-In Center Focus Groups

Drop-In Center Supportive Services Data
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Operational Definition of Homelessness

• Camping with no permanent home to return to
• Doubling-up temporarily with another family
• Having no permanent place to return to after
  hospitalization
• Living out of a car
• Living in an emergency or transitional shelter
• Living in an abandoned building
• Couch surfing

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Determining Homeless Status

NO
Have and address?
Homeless
YES
NO
Whose home is it?
Is it your home?
YES
Answer
Not Homeless
YES
Is your name on the lease?
NO
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Determining Homeless Status
YES
Do you pay rent there?
Not Homeless
NO
gt 6 months
How long have you lived there?
gt 3 months
lt 6 months
Homeless
How long can you stay there?
lt 3 months
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Common Medical Problems

• Skin infections / infestations
• Upper respiratory infections
• STD
• Dental caries
• Vision impairment

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Common Medical Problems

• Mental illness
• Bipolar disorders
• Depression
• Schizophrenia
• ADHD
• Substance abuse
• Tobacco
• Drugs
• Alcohol

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Client Barriers to Care

• Cognitive immaturity
• Denial
• Lack of knowledge
• Lack of skills
• Fear of exposure and loss
• Lack of perceived need or priority
• Lack of social support
• Lack of adherence to schedules

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Structural Barriers

• Lack of perceived need
• Inconvenient space, hours, travel
• Unaffordable
• Judgmental
• Not confidential

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Structural Barriers

• Lack of social support
• Not adolescent-oriented
• Not male/gay/lesbian inclusive
• Discontinuous or uncoordinated care
• Legal

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Overcoming Barriers

• Educate adolescent clients
• Provide a social support
• Assist with adherence to appointments
• Provide adolescent friendly atmosphere
• Provide non-judgmental services
• Ensure confidentiality when appropriate
• Make it affordable

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Drop-In Center

• Separate from adult clinic
• In an area that kids are /frequent/travel through
• Supportive services on-site
• Adolescent friendly staff
• Peer leaders