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Pearls of Wisdom Sharing best practices, anecdotal experiences and clinical challenges in serving ho

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Peggy Akers (HCH Portland, ME) Isabella Christodoulou (The Drop ... rapid decompensation. from CC Dx. Persons Experiencing Homelessness. Objectives: (:80 min) ... – PowerPoint PPT presentation

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Title: Pearls of Wisdom Sharing best practices, anecdotal experiences and clinical challenges in serving ho


1
Pearls of Wisdom Sharing best practices,
anecdotal experiences and clinical challenges in
serving homeless youth and adolescents
  • Peggy Akers (HCH Portland, ME)
  • Isabella Christodoulou (The Drop In Center, New
    Orleans)
  • Daneé Sergeant (The Drop In Center, New Orleans)
  • Wayne A. Centrone (Outside In, Portland, OR)

2
Christine Hanlon, 2007
3
Social Instability Emotional Instability Mental
Instability
Sapolsky Marmot Adler
Persons Experiencing Homelessness
STRESS
? stress unmet HC needs rapid
decompensation from CC Dx
4
Objectives (80 min)
  • Describe the unique cohorts that are HY/A, HYA,
    and Hard to Serve (YIHA) (10 min didactic)
  • Discuss a model program to reach HYA in New
    Orleans, LA with a special emphasis on the
    mental health needs of HYA (20 min didactic)
  • Discuss a model program to reach hard to serve
    HY/A and HYA in Portland, ME (20 min didactic)
  • Invite audience into a moderated discussion and
    QA session about model and unique approaches to
    serving HY and HYA (30 min QA session)

5
The estimated number of street children and youth
in the world ranges from 30 to 170 million
  • United Nations, Department of International
    Economic and Social Affairs, The Situation of
    Youth in the 1980s and Prospects and Challenges
    for the Year 2000. New York United Nations,
    1986.

6
Homeless Abandon Youth
  • 730,000 to 1.3 million nationally
  • 25 Permanently homeless 50 Runaway secondary
    to abuse
  • 75 Engaged in illegal activity 50 Involved
    with prostitution
  • 50 Alcoholic, 80 Street Drugs, 35
    Intravenous Drug Use
  • Often engage in survival sex which increases
    the likelihood of STDs and unintended
    pregnancies
  • Noell J, et al. Childhood sexual abuse,
    adolescent sexual coercion and sexually
    transmitted infection acquisition among homeless
    female adolescents Child Abuse and Neglect
    25(1) 13748, Jan 2001.

7
Why are U.S. Youth Homeless?
  • Family conflict and abuse
  • 60-75 report serious sexual and physical abuse
  • Economic problems in the home of origin
  • Aging out of foster care
  • Gay, lesbian, bisexual, transgender, questioning
    (GLBTQ)
  • Residential instability
  • School and learning
  • Powers J, Eckerd J, Jaklitsch B. Maltreatment
    among run away and homeless youth. Child Abuse
    Negl 19901487-98.

8
Why are U.S. Adults Homeless?
  • Lack of affordable housing
  • Low paying jobs
  • Substance abuse and lack of needed services
  • Mental illness and lack of needed services
  • Domestic violence
  • Unemployment
  • Poverty
  • Prison release
  • U.S. Conference of Mayors. A Status Report on
    Hunger and Homelessness in Americas Cities a
    27-city survey. December 2001.

9
There are over 2,000 homeless youth in Portland,
OR Citizens Crime Commission Joint Homeless
Youth Assessment Committee March 1998 Portland,
OR.
10
Background Data
  • Persons experiencing homeless have
    disproportionate rates of chronic illness and
    death (OConnell, 2005)
  • Higher morbidity burden in AEH (Richardson, 2003)
  • Young adults experiencing homelessness are less
    likely to engage conventional care environments
    (Auerswald and Eyre, 2004)
  • The provision of healthcare services to young
    adults experiencing homelessness must be
    specialized and targeted (Barry, 2002)
  • There is a growing population of youth
    identified YAEH who require specialized and
    targeted care delivery (Theory)

11
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12
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13
Housing Unsuitable for Habitation
Unsuitable for Habitation Living on street,
camping, living in vehicle, sleeping in
park/under bridge/freeway, travel with no fixed
home
14
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15
Credited to Dr. Seth Ammerman, Stanford
University Department of Pediatrics, Division of
Adolescent Medicine, Packard Childrens Hospital,
Palo Alto, California
16
Who is a Road Warrior?
  • Anecdotal Definition
  • lt25 year old (actuality 24-30 y/o)
  • Homeless gt 30 days out of past year
  • Not otherwise engaged in services (such as
    housing, case management, etc)
  • Hard to reach/serve persistent mental illness
  • Drug/alcohol dependent (much higher than
    housed-matched cohort and adult PEH)
  • Socially isolated (chronically)
  • Marginalized economically, academically,
    socially, and developmentally

17
Who is a Road Warrior?
  • Psycho-Social Information
  • Physical Trauma/abuse
  • Frequent physical/mental/sexual abuse and trauma
  • Chronic Homelessness
  • 81/144 (56) reported being homeless gt12 months
  • Mental Illness
  • High rates of depression, suicide
  • Drug and Alcohol Use/Abuse
  • gt40 report using injection drugs
  • 44 reported needs for alcohol/drug treatment
  • gt80 w/ self reported daily Etoh use
  • Extracted from case manager reports, 2003

18
Barriers to Accessing Services
  • Kept late hours tended to be seeking engagement
    after most programs were closed
  • Drug/Alcohol affected and dependent
  • Isolated Rough Sleepers
  • Disconnected from other street youth
  • Counter-culture (distinctive)
  • Disliked requirements
  • for engagement
  • Clinic too institutional

19
Creating Bridges for Care Delivery
  • Get the story dont be afraid to inquire about
    housing status vulnerability index (Kuhn,
    Culhane)
  • Encourage ANY positive change (Hudson)
  • Promote flexibility and creativity (Pires)
  • Communicate with case managers and social workers
    (Kushel)
  • Advocate make the hand off help to connect
    patient to a primary care relationship (Salit,
    Petterson)
  • Promote professionalism and respect in every
    patient care interaction (Hwang)
  • Recognize the continuum cohorts of risk w/in
    HY/A

20
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21
Literature Cited
  • Abdalian SE. Street Youth Mortality Leaning
    With Intent to Fall. JAMA. 2004 292 624-626.
  • Barkin SL, Balkrishnan R, Manuel J, Andersen RM,
    Gelberg L. Health care utilization among homeless
    adolescents and young adults. J of Adoles Health.
    2003 April32(4) 253-256.
  • Dahl RE. Adolescent brain development A period
    of vulnerabilities and opportunities Keynote
    address. Annals of the New York Academy of
    Sciences. 200410211-22.
  • Haldenby, et al. Homelessness and Health in
    Adolescents. Qual Health Res. 200717 1232-1244.
  • Hwang SW. Is homelessness hazardous to your
    health? Obstacles to the demonstration of a
    causal relationship. Can J Public Health. 2002
    Nov-Dec93(6) 407-10.
  • Lam JA, Rosenheck R. Street Outreach for Homeless
    Persons with Serious Mental Illness Is It
    Effective? Medical Care. 199937(9) 894-907.
  • Neaigus A, Friedman SR, Sufian M, Stepherson B,
    Goldsmith D, Des Jarlais DC, Mota P. Peer culture
    and risk reduction among street IV drug users.
    Int Conf AIDS. 1990 Jun 20-236 226.
  • Noell J, et al. Childhood sexual abuse,
    adolescent sexual coercion and sexually
    transmitted infection acquisition among homeless
    female adolescents Child Abuse and Neglect
    25(1) 13748, Jan 2001.
  • O'Connell JJ. Dying in the shadows the challenge
    of providing health care for homeless people. Can
    Med Assoc J. 2004 April170(8) 1251-1252.
  • OConnell JJ, Swain S. Rough Sleepers A Five
    Year Prospective Study in Boston, 1999-2003.
    Presentation, MHSA 10th Annual Ending
    Homelessness Conference, Waltham, MA, 2005.
  • Pires SA, Silber JT. On Their Own-Runaway and
    Homeless Youth and Programs that Serve Them.
    Children and Youth at Risk Project. Georgetown
    University, 1991.
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