Title: Meeting the health care needs of homeless youth through strategic partnerships
1Meeting 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
2Homeless 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
3Homeless 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
4Continuum of Support
5Larkin 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
6Larkin Street Youth Profile
Mental Health Issues
7Larkin Street Youth Profile
Substance use past year
8Larkin Street Youth Profile
HIV Risk Behaviors Previous 30 Days
9Larkin Street Clinic Youth Profile
10Larkin Street Clinic Youth Profile
11Larkin Street Clinic Youth Profile
12Street Outreach
- Often first contact for street youth
- Provides food, socks, prevention and hygiene
packs - Consistency of schedule
- Safety
- Respectful documentation
13Street Outreach
- Rapport and trust building
- Respect of youths space
- Flexibility
- Importance of listening
14Harm Reduction Approach
- Meets youth where theyre at
- Non-judgmental and strengths based
- Focus on impact of behaviors
- Provides practical strategies that reduce
negative consequences
15Larkin 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
16Clinic 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
17Clinic 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
18Clinic 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
19Clinic Provides
- Confidential services
- Lab tests, treatments, and medications
- Reliable referrals and consultants
- Health system navigation/facilitation
20Meeting 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
21Common Health Issues
- Ability to Consent for care
- Sensitive services
- Medically emancipated
- Legally emancipated
22Common Health Issues
- TB screening - clearance for shelter
- STI screening
- HIV testing
- Family Planning
- Pregnancy testing
- Contraception
- Referrals
23Common Health Issues
- Allergic Rhinitis
- Asthma
- Bronchitis
- Colds and flu
24Common Health Issues
- Skin Disorders
- Pediculosis
- Eczema
- Abscesses and Cellulitis
- Fungal Infections
- Trench foot
- Lacerations
- Bites (insect, animal, human)
25Common Health Issues
- Gastroentestinal Complaints
- Heartburn/reflux
- Ulcers
- Diarrhea
- Gastroenteritis
- Parasites
- Constipation
- Hemorrhoids
- Rectal bleeding
26Common Health Issues
- Substance Use
- Tobacco
- Alcohol
- Marijuana
- Methamphetamine
- Heroin
- Polysubstance use
27Common Health Issues
- Mental Health Issues
- Depression
- Anxiety
- Panic Disorders
- Schizophrenia
- Bipolar disorder
- Personality Disorders
- Conduct Disorders
28Comprehensive 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
29Comprehensive Case Management
- Help youth negotiate the system
- Medical Coverage
- Hospitals
- School
- SSI/DSI
- Probation/Parole/Diversion Programs
- Immigration/Asylum
30Harm Reduction Clinic Perspective
- Motivational Interviewing
- Readiness to change
- Negotiating the health care plan
- Contract
- Follow-up
- ALWAYS LEAVE THE DOOR OPEN
31Case 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.
32Case 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.
33Contact 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