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Meeting the health care needs of homeless youth through strategic partnerships

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Title: Meeting the health care needs of homeless youth through strategic partnerships


1
Meeting the health care needs of homeless youth
through strategic partnerships
Dina Wilderson, Chief of Research and Evaluation
- Larkin Street Kathy Ryan, Nurse Practitioner
Larkin Street Clinic
2
Homeless Youth
  • True or False?
  • Homeless youth have higher rates of mental
    illness than housed youth
  • Homeless youth have higher rates of sexual abuse
    and exploitation than housed youth
  • Homeless youth have higher rates of suicide than
    housed youth
  • Homeless youth are suspicious of traditional
    medical care
  • Homeless youth are under immunized/over immunized

3
Homeless Youth
  • True or False?
  • Homeless youth are at higher risk of HIV
    infection
  • LGBTQQ youth are disproportionately represented
    among homeless youth
  • Homeless youth survive by criminal behavior
    panhandling, stealing, prostitution, drug sales
  • Youth of color are disproportionately represented
    among homeless youth
  • Homeless gender variant youth face additional
    challenges to getting their health care needs met

4
Continuum of Support
5
Larkin Street Philosophy
  • Comprehensive continuum of services
  • Housing as an intervention
  • Support services
  • Intensive case management
  • Youth-focused services
  • Focus on life skills
  • Harm reduction approach

6
Larkin Street Youth Profile
Mental Health Issues
7
Larkin Street Youth Profile
Substance use past year
8
Larkin Street Youth Profile
HIV Risk Behaviors Previous 30 Days
9
Larkin Street Clinic Youth Profile
10
Larkin Street Clinic Youth Profile
11
Larkin Street Clinic Youth Profile
12
Street Outreach
  • Often first contact for street youth
  • Provides food, socks, prevention and hygiene
    packs
  • Consistency of schedule
  • Safety
  • Respectful documentation

13
Street Outreach
  • Rapport and trust building
  • Respect of youths space
  • Flexibility
  • Importance of listening

14
Harm Reduction Approach
  • Meets youth where theyre at
  • Non-judgmental and strengths based
  • Focus on impact of behaviors
  • Provides practical strategies that reduce
    negative consequences

15
Larkin Street Youth Clinic
  • Department of Public Health Clinic
  • Co-located with Larkin Street Youth Services
    Drop-In Center
  • Outreach services through Larkin Street
  • Referrals to Community Based Mental Health and
    Hospital Based Specialty Medical Services

16
Clinic Services
  • Between July 1, 2007 and June 30, 2008
  • Served 704 youth
  • Provided 2,511 visits
  • Provided 533 specialized care appointments with
    HIV youth
  • Conducted 170 HIV tests

17
Clinic Services
  • Drop-in services complete physicals by
    appointment.
  • Services
  • Primary care physical exams, immunizations,
    tuberculosis screening, etc.
  • Family planning and reproductive health care
  • Pregnancy testing
  • Emergency contraception ("Morning After" Pill)
  • HIV testing and counseling (Rapid Test available)
  • Specialty Clinic for HIV positive youth
    (Tue/Thur)
  • STD prevention, screening and treatment

18
Clinic Services
  • Urgent Care for common health problems
  • Health Education, nutritional counseling
  • Referrals for eye exam, dental care and podiatry
  • Mental health and substance abuse screening and
    referral (with Larkin Street)
  • Medical Application Assistance
  • Case Management through Larkin Street

19
Clinic Provides
  • Confidential services
  • Lab tests, treatments, and medications
  • Reliable referrals and consultants
  • Health system navigation/facilitation

20
Meeting Health Care Needs
  • Health care for homeless youth must be
  • Accessible/convenient
  • EASY
  • Have minimal paper work
  • Free/low cost
  • Welcoming/non-judgmental
  • Culturally and linguistically appropriate

21
Common Health Issues
  • Ability to Consent for care
  • Sensitive services
  • Medically emancipated
  • Legally emancipated

22
Common Health Issues
  • TB screening - clearance for shelter
  • STI screening
  • HIV testing
  • Family Planning
  • Pregnancy testing
  • Contraception
  • Referrals

23
Common Health Issues
  • Allergic Rhinitis
  • Asthma
  • Bronchitis
  • Colds and flu

24
Common Health Issues
  • Skin Disorders
  • Pediculosis
  • Eczema
  • Abscesses and Cellulitis
  • Fungal Infections
  • Trench foot
  • Lacerations
  • Bites (insect, animal, human)

25
Common Health Issues
  • Gastroentestinal Complaints
  • Heartburn/reflux
  • Ulcers
  • Diarrhea
  • Gastroenteritis
  • Parasites
  • Constipation
  • Hemorrhoids
  • Rectal bleeding

26
Common Health Issues
  • Substance Use
  • Tobacco
  • Alcohol
  • Marijuana
  • Methamphetamine
  • Heroin
  • Polysubstance use

27
Common Health Issues
  • Mental Health Issues
  • Depression
  • Anxiety
  • Panic Disorders
  • Schizophrenia
  • Bipolar disorder
  • Personality Disorders
  • Conduct Disorders

28
Comprehensive Case Management
  • Every member of the team is important
  • Utilize skills of team
  • Social work
  • Education
  • Mental health
  • Medical
  • Art/music programs
  • Parent/guardian if available

29
Comprehensive Case Management
  • Help youth negotiate the system
  • Medical Coverage
  • Hospitals
  • School
  • SSI/DSI
  • Probation/Parole/Diversion Programs
  • Immigration/Asylum

30
Harm Reduction Clinic Perspective
  • Motivational Interviewing
  • Readiness to change
  • Negotiating the health care plan
  • Contract
  • Follow-up
  • ALWAYS LEAVE THE DOOR OPEN

31
Case Study 1
  • Tony - 23 yo Caucasian male in foster care group
    homes since age 6. Entered services age 17,
    legally emancipated. Hx of severe abuse. Morbidly
    obese, hypertensive, pre-diabetes, bipolar
    disorder, PTSD.
  • Very bright, characterized as manipulative,
    litigious. Refers self to various services.
    Multiple health care providers.
  • Very energy-intensive then disappears for months.
  • Records from multiple hospital admissions from
    around the country characterize patient as deaf,
    unable to read ( although he files his own
    petitions to the court) etc.

32
Case Study 2
  • Angie was 17 when she entered services. She had
    a long history of foster care, was depressed,
    poly-drug user, self-cutter. She was extremely
    guarded, hesitant to discuss her past. She went
    through a period of severe depression, was
    suicidal, and minimally functional. Over time
    and with intensive case management, she
    stabilized, got training as a vet assistant and
    moved into an apartment with a friend.

33
Contact Information
  • Dina Wilderson, PhD
  • Chief of Research and Evaluation
  • Larkin Street Youth Services
  • 1138 Sutter St.
  • San Francisco, CA 94109
  • dwilderson_at_larkinstreetyouth.org
  • www.larkinstreetyouth.org

Kathleen Ryan, NP Nurse Practitioner Larkin
Street Youth Clinic 1150 Sutter St. San
Francisco, CA 94109 kathleen.ryan_at_sfdph.org
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