¶ … sufficient health care for runaway teenagers is a topic of grave concern to most in the medical and social professions, both nationally and in the state of California. With limited treatment options, higher risks of STD's, HIV, and other diseases, improper prenatal care, and a lack of community care options, runaway teens receive grossly inadequate health care. This paper will address those concerns, specifically in the state of California, as well as offering possible solutions to the problem, and will examine the role of the registered nurse in the solutions presented. It is important to note that the life of a runaway teenager is filled with health risks and danger. Marie and Cheri are just one example. They were 13 when they ran away from home in an attempt to escape a drug addicted father who sexually abused them. With only $200 between them, their food supply and housing was gone within two weeks. By the third week, Marie was in a prostitution ring, and Cheri was addicted to crack. They were living in a dirty, rundown abandoned building, eating from garbage cans, using dirty needles, and having unprotected sex with strangers. Within 4 years, Cheri was diagnosed with HIV, and was pregnant. They have never returned home ("Marie," 2003).

Marie and Cheri's story is not unique, and before discussing the health care problems in relation to runaway teens, it is important to understand the scope of the runaway problem in general. According to the second National Incidence Study of Missing, Abducted, Runaway, and Thrownaway Children (NISMART-2) by the Office of Juvenile Justice and Delinquency Prevention (OJJDP), published in October, 2002, there were and estimated 628,900 children under the age of 18 listed as runaways at some point during the study. An additional 374,700 children were listed as missing with unknown causes. Of the youths listed as runaways or throwaways, an estimated 3,600 children remained unaccounted for throughout the study (OJJDP, 2002).

In the state of California, according to the California Office of the Attorney General, in 2002 alone there were 104.866 suspected runaways within the state. An additional 5,069 children under the age of 18 were listed as missing with unknown causes. Of those listed as runaways, 5.8% remained missing (COAG, 2002).

Understanding the activities of those runaways can help in reviewing their need for health care options. Almost 68% of runaways are between the ages of 15-17. According to the NISMART-2 study, children at these ages are much more likely to engage in activity that is dangerous, and hazardous to their health. Those activities include substance abuse (19%), known association with drugs (17%), known involvement in criminal activity (11%), known sexual promiscuity (5%), and known sexual activity in trade for shelter, money, drugs, or food (2%) (OJJDP, 2002).

These types of activities put the runaway teens at a much higher risk of many diseases and conditions which require health care. According to a study of Minnesota homeless youth, funded by the Centers for Disease Control and Prevention, a staggering 32% have been pregnant. The HIV prevalence rate among runaway youth is estimated to be two to ten times higher than for non-homeless teens, and one study of Houston homeless youth found an HIV rate of almost 13% (American Civil Liberties Union, 2003). In addition, a national study by the Center for Disease Control concluded that, "Although adolescent women in [runaway] settings had high STD and pregnancy rates, access to STD and other reproductive health services is limited" (Wang, 2002).

One of the main barriers to obtaining these health services is the lack of parental consent. In California, and in many other states, parental consent is required for certain medical procedures and testing for children under the age of 18. These services, according the California Code 6902 include "X-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care under the general or special supervision and upon the advice of or to be rendered by a physician and surgeon..." (Weisz, et al., 1998, p 9). For runaway...

Since the teen has no legal guardian present, and cannot obtain parental consent, there if often no opportunity to obtain the medical services needed in many states. Tied with the higher risks of illness, addiction, and pregnancy, this can be disastrous.
In response, the State of California has gone to great lengths to assist runaway teens. According to California law, there are circumstances in which the minor can sign for their own medical services. Those circumstances include medical emergencies, pregnancy tests and prenatal care, birth control, STD and HIV testing, abortion, metal health treatment and counseling, rape treatment, and drug treatment (Weisz, et al., 1998). In these situations, minors over the age of 12 are allowed to self-consent.

In addition to these circumstances, California has also made the situation easier for runaway teens by allowing consent from those other than a legal guardian. A form, called the "Caretaker Consent form," allows adults who are not the legal guardian, but who do care for the minor, to sign for certain medical procedures. The persons allowed to sign this form on behalf of the minor include related adults, non-related adults, boyfriends/girlfriends, and foster care parents (Weisz, et al., 1998).

While these measures have certainly helped the health care situation of runaway teens, they also lead to the second major barrier of obtaining health care for runaways, that of a lack of health insurance or income. The person who consents to the medical services is also held responsible for the payment for those procedures. According to California law "If a minor is entitled to consent to a certain medical procedure, she is liable to the doctor for the cost of the treatment." (Weisz, et al., 1998, p. 16).

Wilder Research Center report in 2001 showed that an estimated 14% of the runaway youth population reported needing to see a doctor about a current health condition. Yet due to a lack of health insurance and income, 65% of those teens did not see a primary care physician. In addition, 31% of the runaway youth reported being told by a physician in the last two years that they have a serious mental health problem. Due to lack of insurance or income, only 20% of those youths received treatment (Wilder Research Center, 2001).

California has made some attempts to alleviate the financial burden of runaway patients in some circumstances. A minor who believes they are pregnant, and do not or cannot gain parental consent for care can apply for the "minor consent services" MediCal card. The MediCal system will provide pregnancy testing, prenatal care, aid with medical bills of delivery, and also abortion, if the minor chooses this action (Weisz, et al., 1998).

Also, California has broken new ground in an attempt to make health care even more accessible to runaway teens. The Children's Hospital of Los Angeles has developed the "High Risk Youth" program. The goal of the program is "consolidating a number of existing treatment resources, increasing awareness and access..., and developing a staff of professionals specifically trained to deal with needs of high risk adolescents." (Children's Hospital of Los Angeles, 2004). Their programs include a Youth Clinic, which provides free medical care to teens under the age of 18, "Project Homeless Youth," which provides emergency outreach services, and the "Mobile Team Project," which provides screening and health care at shelters (Children's Hospital of Los Angeles, 2004). These types of programs are available in most of California's major cities, and may include community outreach centers, Social Service centers, volunteer homeless shelters, and Runaway teen hotlines.

In addition, California uses the talents of the registered nurse (RN) to facilitate aid to runaway children. The RN is a vital component to these programs. By using the RN's expertise in both medical and mental health fields, mobile care units can access the problems directly in the community, without the need for a doctor on site. The RN can travel with the mobile units, and serve part or full time within the shelter programs, ensuring proper care for runaway teens (California Board of Registered Nurses, 2003). In this way, the RN brings the care needed to the runaway, rather than forcing the runway into a health care system.

In addition, the RN is a vital component to most outreach community services, and free clinics. By allowing the RN to tend to the patient, and to educate runaway teens on risk behaviors, and how to avoid them, they are lessening the likelihood that those teens will require services for drug abuse, teen pregnancy, and STD's (Advanced Practice Registered Nurses Council, 2004).In addition, the RN is often responsible for the arrangement for community health screenings for HIV, STD's, infectious disease outbreaks, and vaccination efforts within the runaway and homeless communities (California Board of Registered Nurses, 2003).

In addition to the health services provided by the RNs, they are also major advocates for increased health care of the runaway population. Part of the role of the RN is to advocate for the patient, initiating actions in an attempt…