Abstract
Homelessness in the world is significant humanity problem, which while many will acknowledge needs to be resolution, they also seemed to be unmoved with making a change. The stigmatization associated with homeless people is spread through the misinterpretations of the reasoning of how the individual arrives at their situation. This is largely a problem for the ever increasing population of homeless youth which has risen in the last several years due to the economic situation and familial factors in which self-determination and perseverance take priority. The problems that many homeless individuals face as well as youth is the lack of healthcare. Exposed to the environmental conditions runs the dangers of making risky decisions that places many in risks of contacting infections, diseases, mental problems, and death. It is important in understanding that the health concerns differ from adult to youth. It is important to understand the how the effects of homelessness affect the physical, social, and mental aspects of the development in youths. In that respect greater research, programs, and legislation can be created to greater treat those that are in dire need.
In the United States alone, there are over 8 million people that are identified as homeless, with more than 26 million people that can identify that they were homeless at some point in their life. Due to the recent fluctuations in the economy the number of homeless youth is becoming an increasing problem not only in America but around the world. As economies and governments are collapsing, many are left in the straits of poverty and with little places to turn to. One of the most essential problems is the seemingly undressed problems of providing healthcare to homeless youth. The homeless youth and those that live within homes face the similar issues and health concerns, but they are experiences that may affect them cognitively, physically, and psychologically can force them to make bad choices. It is due to these concerns that homeless youth are able to benefit from services that are specific to their needs, when it comes to health care rather than amalgamated into services for the adult homeless population. For the purpose of this paper, it will address the concerns of the importance of health and social services for the needs of the homeless youth and the delivery of healthcare. This paper will identify the pressing needs associated with homeless youth that includes, social, physical, and mental development, and recommend best practices and public policy in treating the homeless youth population.
In identifying the health profile of the homeless youth population, it is necessary to look at the complicated and confusing identification of the homeless population. The homeless population in general is commonly looked down upon, and many view the situation as a matter of personal failures. Even while the number of people that are subjected to homelessness grows, there is a continuation of the broad stigmatization and stereotyping that make it easier for people as well as politicians to ignore. (Buck et al, 2005) The general stereotypes include people that are lazy, welfare dependent, mentally disabled, or substance abusers. The current notation that being homeless is a person’s own fault is to shift the social responsibility of the public to the person. This has been typified in the legislation passed by local policy makers, which create laws that make it more difficult for homeless individuals. This is includes making it a criminal act for people to sit, sleep, or store personal belongings in public spaces. Loitering specific towards homeless people, police sweeps that drive the homeless out of the city area where they are able to destroy their personal property, and laws that punish panhandling. These notions are extenuated by the limited contact and lack of interaction with homeless individuals. One bad experience seems to typify an entire group that leads to negative attitudes. (Hocking, Lawrence, pg. 97-98, 2000) The negative attitude towards the homeless extends towards the youth population as well. Many view them as rebellious runaways and troublemakers that were likely kicked out because their parents viewed them as out of control. The Local Children and Families Commission conducted a survey that shown that a majority of the public believed that homeless youth were the culprits in many of the crimes throughout cities. Many of the population still do not have a clear view of the profile of homeless youth.
According to the Children’s Health Fund, it included a survey from the United Sates Conference of Mays that showed that homeless youth account for over 5 percent of the homeless population. (Children’s Health Fund, pg. 3, 2005) With over the course of a single year, the number of homeless youth can increase from half a million to over a million. While there are several programs and advocates that have created homeless shelters, many youth are reluctant to enter shelters. In most major cities, the agencies that are tasked with addressing the problems of homelessness usually fall into two categories, children and single adults. In defining what is homeless the definition used is “to be counted as homeless a person must both lack a fixed, regular, and adequate night-time residence and be temporarily domiciled in a shelter.” (Children’s Health Fund, pg. 5, 2005) This definition is lacking in including the population of individuals that live in serious overcrowded conditions such as shared apartments or homes while having no home of their own.. The profile of the homeless youth includes runaways, which leave their homes because of sexual or physical abuse, neglect, running away from foster case or other institutions, youth that were pushed out of their homes by family, discharged youth from juvenile detention centers, and struggling immigrants. Not all youth leave their homes because they want to, but because the toxic environment in which provides a dangerous and oppressive situation that leads to their own view of survival. It is an attitude of self-determination in which provides them the ability to protect themselves from emotion or physical abuse in their environment.
In looking at the aspects of what leads to homeless youth has been largely found that the factors are based on the deficiency of the necessary basic requirements. This includes the presence of economic stability, social support of their peers, lack of affordable housing or shelter, drug or alcohol abuse, divorce, the presence of violence (emotional or physical) in the homes, and behaviors or health conditions that go untreated. The number one factor being family disruption. The problems in the family dynamic that generally lead to youth homelessness is irreconcilable, and the disruptions are usually an impetus for running away. According to survey, “29 percent of homeless respondents report abuse or neglect in childhood from someone in their household (12 percent neglect, 22 percent physical abuse, and 13 percent sexual abuse.” (Tyler, Cauce, Whitbeck, pg. 360, 2005) The groups that largely identify with the term “throw-away” are those that have been forced out for several reasons, with a large portion dealing with sexuality or pregnancy. For many that lived in foster case, they are usually shuffled from home to home until they reach the age of 18 in which they are on their own. Usually removed from their own homes due to abuse, drugs, or other circumstances, some foster homes are not equipped to deal with the mental and emotional problems that some children come with. According to the Children’s Health Fund, “aging out of foster care at a certain age, which requires assuming a degree of independence for which the teenager may not be prepared, is also a potential pathway to homelessness.” (Children’s Health Fund, pg.9, 2005) Most of those that age out of the foster care system or from the juvenile detention centers lack the support system needed such as friends or family. Many youth often find themselves locked up because they have no supervision or because they carry the stigmatization of a runaway that breaks curfew. Many that are homeless suffer because of the bleak economic situation in which many adults or teens are not able to obtain employment. When families become homeless the youth become homeless as well and find that they are separated through transitional housing, shelter, or policies of children welfare. Close to 40 percent of homeless youth have been in the foster care system prior to being homeless, and over 50, percent was mistreated beginning in early childhood. Due to the numerous reasons that lead to youth homelessness stemming from problems in early development, there are several health concerns that need to be addressed and treated.
The health profile of homeless youth have placed them at an increased risks for health issues, which includes chronic disease, substance abuse, and mental illness. The daily environment and circumstances that the youth are subjected to dealing with homelessness poses significant concerns to decision making. Youth are more likely to participate in high risks behaviors that includes, sex with multiple partners that includes a higher risks for STDs, HIV/AIDS, pregnancy, and sexual abuse. The unstable situations and living conditions of facilities and shelters are mostly complicated due to unsanitary conditions, lack of personal hygiene, and non-access to bathroom facilities or running water. Living on the streets leads youth to exposure to hard drugs, street economy, substance and sex abuse that contributes to the overall deterioration of their health. The problems that plague a majority of youth include mental, emotional, medical, and other illnesses. The existence of the conditions prior being homeless is usually expounded upon due to their situation, or a result from their homeless experiences. (Milburn, Rotheram-Borus, Batterham, Brumback, Rosental, pg. 175, 2005) Exposure to homeless leads to an increase in diarrheal diseases, respiratory infections, skin infections, dental disease, and genitourinary infections. According to Fatel and Greydanus (2002), “28 percent of the homeless youth population are diagnosed with a chronic condition that requires ongoing medical maintenance.” (Patel, Greydanus, pg. 72, 2002) There is also a problem with lack of proper immunizations and nutritional deficiencies, along with chronic diseases that commonly go untreated in homeless youth. (Children’s Health Fund, pg. 8, 2005) Bad decisions like survival sex or substance abuse places homeless youth at increased risks for mental and medical issues.
The needs of homeless youth greatly differ from youth that live in a stable home. While they may experience similar social and growth issues, the conditions of living on the streets places a greater strain on the social, mental, and physical development. Socially homeless youth are more likely to participate in unwise and dangerous decisions and behaviors that include stealing, needle sharing or drug abuse, panhandling, sex for shelter, food, or money, and other decisions that put them at risks that includes the judicial system. Homeless youth suffers mentally from being felt like an outsider by friends, family, and the system. The feelings of loneliness, distrust, and low self-esteem are prevalent in many cases. There are many barriers that homeless youth face that affect their overall health that includes, the lack of ability to obtain an education or work. Some are not able to attend school or find it difficult because of lack of transportation, access to facilities, meet residency requirements, legal guardian issues, and improper records according to the National Coalition for the Homeless. (National Coalition for the Homeless, n.d) Due the difficulty present it creates a barrier to social, financial, and personal development in which affects their behavior.
Mentally, the increased rates of mental illness among the homeless youth population is staging with a reported 50 percent of cases. (HRSA, 2010) Rates of depression are also elevated with emotional distress that range from 10 to 26 percent. (Board on Children, Youth, and Families, pg. 99, 2009) The number of cases for suicide and suicide attempt are the highest within the youth population, with many repeated attempts. Like in the adult population substance abuse in accordance with serious mental health problems is not uncommon. The experience with any form of abuse has been on the main factors of youth runaways, but since they have been exposed to violence at such an early age at home and on the street it has affected them mentally. There is overwhelming support that suggest over half the percent of homeless youth have witness street violence that includes, stabbing, shooting, some form of assault, fighting, sexual assault, murder, or have been a victim of violence. (HRSA, 2010) Disturbingly studies have found that these youth suffer from posttraumatic stress disorder (PSTD), and are at an increased risks of learning to use lethal force as a tactic for survival or resolving conflicts. According to research, Homeless youth, “exhibit psychiatric disorders at a rate six times greater than the general youth population, with between 66 and 89 percent of homeless youth having symptoms of one or more disorders.” (Merscham, Leeuwen, McGuire, pg. 100, 2009) The number substantially increases with the population of those that identify with lesbian, gay, bisexual, transgender or questioning. These homeless youth populations are at the highest risks, but are the least likely to have the ability to access proper healthcare.
The service needs of the homeless youth population greatly differ from adults that are homeless. Although they also are in need of access to the health care system, homeless youth has a greater risk of mental and physical health problems. In addition to being prevalent to increased health risks, they are faced with continual barriers to health care access. “These include lack of insurance, a need for parental consent, difficulty navigating the health system, and the attitude of health staff.” (HRSA, 2010) Traditionally, homeless youth have been reluctant to access health and social services that create problems in creating programs and adequate documentation. The barriers to health care are coupled with the status of runaway, where parental or guardian consent is an issue, where the eligibility for low cost insurance such as Medicaid is complicated. The psychological and physical barriers also keep access for health at a minimal over the lack of transportation, fear of being judged, and the role of self-treatment. Barriers that healthcare facilities have with assistance the homeless youth and adults are the mobility of the population with create persistence challenge of follow-up and continual care. Medial needs being on the lower scale of priorities, as well as medication compliance, appointments, due to other necessities such as shelter, food, and survival. (Direction Home, pg. 4, 2013) The lack of storage or refrigeration make it difficult to keep needles or other medications, and finding providers that will offer services to patients that require specialty services.
In providing health care to the homeless youth population, programs, policies, and agencies must address the barriers that interfere in the medical needs of the population. The plan of action for healthcare should incorporate, staffing, funding, implementation strategies, prevention strategies such as “initial screenings, clinical preventive/primary care services for acute and chronic conditions, diagnostic tests, pharmacy service, follow-up methods, and a referral system for specialty care, dental care, mental health, transportation, and social services.” (Directions Home, pg. 5, 2013) In each community, the needs of the homeless youth population will vary, but not much, however a needs assessment of the community is needed in being able to estimate target size, the area with the greatest need, and getting information from the youth. The needs assessment will provide proper case management techniques that will properly link the homeless youth to providers, and services they need. Creating a place that allows for accurate record keeping and repository where individuals can keep important document is essential in providing more people with adequate access to mental and physical care. Providing a place where youth can have medical services that are separate from homeless adults will attract more individuals. The best practices are providing a comprehensive site that provides care for substance abuse, mental illness, primary care (medical and dental), social services, and housing. This will help more youths be trustful of authority and programs that have been created to help them, and are sensitive to their needs. Push for public policy that will allow for separate facilities, or provide additional and separate services in already establish clinics. Searching for financial support from agencies, lobbying legislation for changes to public funding, and homeless and healthcare advocate to gain funding.
The health outreach to individuals is essential in reaching the disparate groups that are not able to obtain access for several reasons. There have been several success models of programs that have tackled the issue of healthcare for the homeless youth throughout the United States. The homeless youth population is the most susceptible to harsh existence of homelessness. Although their health needs are similar to adults, because they are younger they are at higher risks for dangerous behaviors that could affect them mental, physical, and socially. By providing services that address their specific needs, it will help in helping adolescents transition to adulthood, and help them get off the street.
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