Empowering Homeless Youth Finding a Way Back

Abstract
Much of the research that shaped this paper reflected how the most functional adults were able to make the transition from adolescence to adulthood with the emotional and financial support of their parents. Homeless youths don’t have such pillars to rely upon and if they’re going to successfully transition into productive, stable adults free of psychological scars, drug addiction or other destructive tendencies, there needs to be a social support entity who is able to fill in some of these parental gaps and offer these young people protection, guidance and support. This paper also looks at the risk factors in connection with LGBTQ youth who are often kicked out of their familial homes, and who are subjected to more health risks and dangers on the streets and in the foster care and shelter system. This paper examines the more common traumas that face homeless youth and the best structural components of social work to confront these traumas. Finally, this paper examines some of the methodologies used to address the nuances of this complex problem. For example, spiritual development and psychological treatment can help young people build internal reserves of resilience and coping mechanisms to help them deal with the inevitable setbacks and uncertainty of life. Much of this research will orbit around the work done at ACR Health for the good and improvement of youth homelessness. ACR Health is a non-profit, community centered organization that offers support services for people with a range of diseases and works to provide targeted prevention of STDs and offer sexual health services to individuals.
Introduction
It’s difficult to pinpoint the exact number of homeless youths that emerge on the streets each year, but the number is likely between 1.5 and 2 million (Dworsky, 2010). For some of these youths, the homelessness is just a temporary episode, and for others, it’s an ongoing fight for survival. The manner in which these young people end up on the streets is as equally diverse as they are: some of them run away, often running from abusive homes, or are forced out—this is how many pregnant or LGBTQ teens end up on the street. Others are homeless because they’ve aged out of the foster care system or out of juvenile hall (Dworsky, 2010). The experiences that homeless youths have on the streets are as diverse as the reasons that brought them there. Understanding the background of homeless youths is crucial in order to illuminate the best ways to help them. This paper will look at the multi-faceted needs of homeless youth and how ACR attempts to meet those needs. Some of the most basic tactics involve assessing if there can be any familial reconciliation, and in many cases it is in the best interest of the youths involved if there isn’t such a resolution. This paper will explore how stability is created and maintained for these young people, and the type of goal setting that is involved in order to help them make the transition to stable adulthood. Exploring these goals and intention was a massive part of this research project. The bulk of this project involved interviewing and shadowing Tyler Gilyward, the director of Youth Housing at ACR. Mr. Gilyward was able to aptly illuminate for me many of the obstacles that ACR has in helping homeless young people exit homelessness permanently and demonstrate through real life examples how the company attempts to navigate many of those examples. This project that was conducted with the help and insight from Mr. Gilyward was able to illuminate some of the nuances of more theoretical musings on this subject.
Agency Name and Description
The agency in question that was studied both in person and through research goes by the name of ACR Health: AIDS Community Resources. The mission of the organization is to provide health services to all people suffering from chronic diseases, regardless of age, gender, ethnicity, income with a focus on those suffering from HIV/AIDS in the northern counties of New York State, such as St. Lawrence, Oswego, Oneida and other northern counties close to Canada and Vermont (ACR Health, 2018). Aside from working with people who have HIV/AIDS, they also work with people who are struggling to deal with diabetes, obesity, heart disease, drug addiction, mental illnesses and asthma with the ultimate goal of helping individuals to effectively manage their conditions so that positive health manifestations occur and remain consistently. Another pillar of the work that ACR does is that it helps guide and empower individuals to make better decisions that will manifest better outcomes for their health and safety (ACR Health, 2018). This is an aspect of the work that they do via specific STD and unwanted pregnancy prevention and a component of the sexual health services they offer to individuals. Ultimately the organization endeavors to bolster the wellness of all who need such help in their communities and to be the pillar that assists people in achieving that (ACR Health, 2018). As Tyler Gilyward, the director of Youth Housing, explains, a lot of the young people they work with come from homes and families that have perpetuated a legacy of neglect. Many of the youths they work with don’t know about basic things they’re supposed to do to stay healthy and to ward off disease, such as brushing their teeth twice a day (T. Gilyward, Personal Communication, February 13, 2018). “It may sound silly, but many of these young people weren’t taught the basic health behaviors that would keep them safe and prevent disease. So a lot of what we do is we help to bridge so many of the gaps in that their parents left during their development” (T. Gilyward, Personal Communication, February 13, 2018).
Principles and Goals of Case Management
Effective case management has long been connected with reaping positive outcomes with homeless youth. However, in 2018 effective case management has to have an electronic component, particularly when dealing with youths (Bender et al., 2015). According to Gilyward, the team at Youth Housing does incorporate an electronic case management component to their work as sometimes the teenagers have logistical barriers that stop them from showing up at in-person meetings (Bender et al., 2015), and because communicating over electronic technology is second nature to these youths. Tyler Gilyward explains, that when funding allows it, the youths receive prepaid cell phones and a case manager who offers four electronic case management sessions every two weeks over a 12-week period. It’s up to the case managers to document how often the youths were active with their phones and responding to calls, emails and texts. Youths generally needed consistent engagement and prodding from case managers to respond, but they generally rate electronic case management in a very positive way. Gilyward explains that teens were most communicative over texting and was very excited about the implications of these results for the future of case management.
In regards to the type of case management model ACR uses, Gilyward described it as “…a hybrid between the Broker Case Management Model and the Clinical Case Management Model, depending on the needs of the individual youth. Some teenagers just need a case manager to collaborate services for them through a range of social service avenues. In these cases, it’s enough to just evaluate their needs, make appropriate referrals and observe the treatment they receive over a period of time. On the other hand, other youths require more from us, and that’s when we incorporate more of the Clinical Case Management Model. This is useful to us as it is more centered on engaging the youths in regular therapeutic interventions such as psychotherapy and crisis interventions” (T. Gilyward, Personal Communication, February 13, 2018). Gilyward went onto explain that they were working with a homeless youth who was HIV positive and engaged in behaviors of self-harm such as cutting. He wasn’t able to promise that he’d be able to stop his self-harming behaviors, not even for a day; the youth said that they were too soothing to him and helped him feel calm. Hence, given the circumstances it was important to make a concerted and lasting crisis intervention. In the case of this youth, he had to be admitted to the hospital for monitoring for a few days, while the best psychotherapists experienced with HIV/AIDS patients met with him, until they were confident that they could trust he would not engage in self-harm. This was achieved in part, by connecting the youth with a team of social support avenues, aside from his case manager, and ensuring that he felt totally supported.
Of course, such a case is extreme. As Gilyward explained, much of case management is very individualized. Each teenager is paired with a case manager and together as a team they help the teen create a self-sufficiency plan or an individual action plan as a result of their strengths and objectives (Dworsky, 2010). For example, for some students a major goal is getting their high school diploma, whereas for others it’s finding a job, and still for others it’s finding a job in a field they want to stay in over the long term. The case manager can be an extremely helpful guide in helping the youth navigate all the resources that are out there.
Three Components of Case Management
According to Tyler Gilyward, the three components of case management are as follows: Build trusting relationships, use evidence based practice, and finally, do all that one realistically can to empower the client. The first component, the creation of trusting relationships is so essential because this is the foundation for working effectively and consistently with the youth. The National Association of Social Workers has long gone on the record asserting that the beneficial and therapeutic relationship between a practitioner and client can have a tremendous impact on how well the case is managed and the number of positive outcomes the client reaps (NASW). Trust is able to flourish once the case manager is able to create a safe environment for the youth, enabling them to share their problems, fears and goals. The case manager needs to convey empathy and at the same time put the client at ease. Research has found that the more empathetic case managers are, the more likely their clients will reap positive outcomes and progress towards lasting improvement (Lacay, 2013).
The next pillar of effective case management refers to the consistent reliance on evidence-based practice. It’s the duty of the case manager to stay current with the best methods of social work, particularly since homeless youths are such a specific group with specific yet diverse needs. For example, 15 years ago, Johnson and colleagues found that in homeless teenagers with HIV/AIDS, it wasn’t enough to give them stable housing and medical care; they needed therapeutic interventions that supported their mental and emotional health (2003). Similarly, just three years ago, Mastropieri and associates found that treatment which supports spiritual development for growth and coping can be a valuable resource for homeless youths, many of whom have suffered immense trauma (2015). The more vigilant one is with staying current with relevant research findings, the more value one can offer this worthy population.
The final component, empower the client is so essential in this line of work, because as Gilyward explains, “many of these homeless youths have had their self-esteem shredded by their parents” (T. Gilyward, Personal Communication, February 15, 2018). Gilyward went on to elaborate that many of these teens, particularly the ones that view themselves as members of the LGBTQ community, have been told how worthless, unclean or evil they are or suffered other forms of abuse from parents or caregivers, something documented by numerous scholars (Ream et al., 2014). Empowering these clients often starts with helping to rebuilt self-esteem and a sense of self-love.

Four Methods of Case Management Service Delivery
Depending on who one asks, there are a variety of methods of delivering service when it comes to case management. And this is largely a result of the fact that many professionals in the field have varying definitions of what case management consists of in clinical settings (T. Gilyward, personal communication, February 15, 2018). Gilyward views case management as a collaborative endeavor that engages in the evaluation, planning, implementation, coordination, observation and assessment of services that are hand-selected based on the client’s needs. While Gilyward agrees that there are four methods of case management service delivery, he thinks there are even more. Some of the examples he offered as the main methods of case management service delivery were: intensive case management, strengths-based case management, brokerage case management, and clinical case management. Intensive Case Management is often ideal for youth who may have a less aggravated acuity, but who are categorized as needing rigorous support for a specific timeframe, one that is often short. In this method of service delivery, plans are developed with the case manager, and skills are honed, often to meet short-term goals. Conversely, strengths-based case management seeks to focus on members of a mentally ill population (which ACR does serve) and help them make the transition to independent living in a house or apartment. This method of service delivery has a dual focus: helping liaison access to resources such as housing and employment, and assessing the client’s strengths as a means for self-management and balancing of resources. As the name suggests, there’s a focus on the strengths that the client already possesses so that this can help the client achieve goals. Gilyward explained that the third method of case management service delivery, Brokerage Case Management, might be the type that has received the most criticism, largely as a result of the narrow amount of contact and communication between the case manager and the youth. Essentially, the case manager meets with the youth, and brokers resources and referrals that might be helpful to the youth, often without ongoing monitoring, or just a short period of such monitoring. Finally, Clinical Case Management is a method that is often employed at ACR largely because the intensity of the youths’ backgrounds warrants it. Clinical case management describes a hybrid of combining resources with therapy, and sometimes even rehabilitation programs for some of these youths. Case managers under this method can instruct specific skills or make referrals to psychotherapists, or engage in psychotherapy, if qualified.
Roles of the Case Manager
It’s common for people to mix up the roles of the case manager with that of the social worker. However, case managers fulfill roles that are specific to their line of work, as the offer help and support to people in need. In the case of ACR Health, their roles are acutely defined. One of the most primary roles is that of the assessor: it is up to them to develop a comprehensive picture of the lives of their clients, gathering their psychosocial information, earlier treatment endeavors, family history, and medical and psychiatric background, as a means of determining if any needs were unmet (Miller, 2017). Another major role that the case manager fulfills is that of the care coordinator: as care coordinator they have to audit all of the services the youth needs and is currently engaging in. Under this role, the case manager might need to communicate with other professionals to address any neglected needs to ensure the youth can meet all goals and get on the desired path to being fully functional and successful. This might include reading self-reporting questionnaires that youths submit, an effective tool for homeless youths and measuring progress (Slesnick et al., 2007). A final yet often overlooked role of the case manager is that of advocacy: “Case managers advocate for their clients, taking necessary steps to ensure that patients who are unable to advocate for themselves don't fall between the cracks” (Miller, 2017). This ensures that the systems at large are forced to improve, so that the field of social work in the non-profit sector becomes more efficient and more helpful.
Three Phases of Case Management
When pressed, Gilyward felt that there were more than three phases of case management; he believed at ACR Health, there were as many as nine phases of case management at any given time. For example, Gilyward plainly stated that at ACR Health, case managers would engage in the process of screening, assessing, determining risk, planning with client, orchestrating implementation of care, monitoring, follow-up sessions, and guiding through transitions (T. Gilyward, Personal Communication, February 15, 2018). However, if he had to condense these numerous phases into three, he would select: Assessment, Planning and Implementation, Monitoring and Follow-Up (T. Gilyward, Personal Communication, February 15, 2018). Assessment is the phase when the case manager is able to take complete stock of the homeless youth: the familial background the teenager comes from, the full health history, the reasons that made the child homeless and other relevant facts. Planning and Implementation of the plan is a building process the case manager and client do together: in this phase they set goals together and the case manager provides resources for the client to meet all relevant goals. Monitoring and follow-up is when the case manager is able to observe how effective the plan is in the life of the youth, and whether any part of it need to be adjusted or if there are any setbacks that need to be addressed or needs that should be met.
Summary
Homeless youths is one of the saddest yet one of the most complex social problems facing our modern society to date. ACR Health is a non-profit organization, which seeks to alleviate this problem, and particularly provide help for some of the most vulnerable members affected, which are LGBTQ youth (Ream et al., 2014). This paper has taken an intimate examination of the inner workings of the organization and the structures and philosophies that guide the ways in which they seek to help homeless teenagers. As this paper has reflected, the organization often uses a hybrid of different models and methods in order to achieve their goals and to help youths most effectively. One thing that Gilyward often stressed was that care models were often forged on a case by case basis determined by what the case managers felt was more appropriate or necessary for each youth. If this program has illuminated anything, it’s shown that a range of methods of service delivery can be useful in helping and empowering this vulnerable population, and that its important to explore a range of techniques and methods, or at the very least to be aware of them. That way, as Gilyward often repeated, each youth can receive a case management plan, which is tailor-made to their needs and circumstances.











References
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