Homeless Youth and Access to Healthcare

Homeless Youth: Access to Healthcare Services

Homeless Youth

Homeless Youth: Increasing Access to Healthcare Services

Homeless Youth: Increasing Access to Healthcare Services

The estimated number people in homeless families in 2014 were 216,261, of which nearly 60% were under the age of 18 (Henry et al., 2014, p. 29). The number of unaccompanied homeless children and youth in 2014 was estimated to be just under 200,000 individuals (p. 39). The U.S. Department of Housing and Urban Development (HUD) defines children as any individual under the age of 18, while youth are defined as being between 18- and 24-years of age. Unaccompanied children represent about 70% of this homeless demographic. Combining these numbers result in about 78,281 and 263,727 homeless youth and children, respectively, living on the streets and in shelters in the United States in 2014, which represent 13.5 and 45.6%, respectively, of all homeless individuals.

Other estimates suggest that the number of adolescents living on the streets is somewhere between 1.5 and 2 million, which would make this age group the primary homeless demographic populating the streets and shelters of America (Hudson et al., 2010). This demographic tends to be sexually active, suffering from substance abuse issues, facing mental health problems, struggling with personal hygiene, and therefore in need of medical services. Given the magnitude of this problem, this essay will examine the barriers these homeless young adults face when seeking medical care.

Homeless Youth

The reasons young adults leave a home to live in the streets are numerous and can include parents kicking them out, escape from physical and/or sexual abuse, gender identity discrimination, parental conflict, family homelessness, by choice, or released from foster care, juvenile justice, or substance abuse treatment centers (HCH Clinicians' Network, 2009; Hudson et al., 2010). These young adults face a number of dangers, including sexual and physical abuse, sexual exploitation, prostitution, and drug/alcohol abuse. In a review by Hudson and colleagues (2010), more than 60% of homeless adolescents responding to a survey reported a history of sexual abuse, 56% reported having injected drugs, and over 12% responded in the affirmative to a question about attempted suicide. Obviously, homeless youth would be susceptible to sexually-transmitted diseases, tuberculosis, hepatitis, addiction to drug and alcohol, and disproportionate suffering from mental health problems. The need for access to quality medical services is therefore great among this demographic.

The consequences are a greater reliance on emergency services for medical care, in lieu of primary care utilization (reviewed by Hudson et al., 2010). Some of the barriers identified by researchers include an unwillingness to interact with social services or law enforcement, unfamiliarity with how the healthcare system functions, non-English speaking, no health insurance, no transportation, and a lack of provider respect towards the homeless. Many of these barriers were validated by a survey of young adults between the ages of 18 and 25, who were living on the streets of Los Angeles (Hudson, et al., 2010). The barriers identified by these participants included restrictive clinic hours and long wait times. If a homeless youth was willing to wait hours before seeing a clinician, they are often assaulted by bad smells and hostile attitudes of other homeless adults in the waiting room, only to be treated dismissively by clinicians if their health complaint does not represent a major medical condition like bipolar disorder or substance abuse. Importantly, Hudson and colleagues (2010) reported that the youth who participated in their study were thankful for the older and more experienced homeless youth willing to provide guidance on where to find needed medical services and how to navigate the 'system.'

In an earlier study, researchers asked 20 homeless female youth between the ages of 14 and 23 about their experiences during attempts to access the healthcare system (Ensign & Panke, 2002). A common theme identified in the data was the need to reorganize clinic waiting and examination rooms to allow family and friends to accompany the client during clinic visits. Other barriers identified by the women and researchers included the lack of clinician cultural competency, but in this case the competency would represent the ability of clinicians to recognize the sometimes large cultural, social, and economic differences between the lives lived by clinicians and the homeless. The homeless women participating in the study repeatedly mentioned a lack of understanding and provider use of negative stereotypes. An example mentioned by the providers was homeless women who engage in sex work to survive and then seek medical treatment. From an ethical perspective, clinicians should be treating these women with the best care they are able to provide, without passing judgment on their status as homeless or involved in the sex trade.

Sociological Perspectives

Conflict theory holds that the wealthy control social outcomes by exploiting the underprivileged. Although the absolute number of homeless people on the streets has been going down over the past couple of years, from 651,000 in 2007 to 580,000 in 2014, there has not been any change in the number of shelter beds available to help the homeless get off the streets. The lack of available shelter beds for the homeless remained unchanged despite the widening gap in income among Americans (Stone, Trisi, Sherman, & DeBot, 2015). The wealthiest 1% experienced a 200% income increase between 1979 and 2011 after taxes, but the bottom 80% experienced a relatively minor 40-48% increase. Obviously, allocating some of this new wealth to shelter beds is not a priority among the wealthy and could be viewed as increasing personal wealth on the backs of the underprivileged and middle-income Americans. Over the past several decades, at least, a rising tide does not lift all boats. The tenets of functionalism seem to be violated by the income inequality data as well, because this theory assumes that society will adapt to regain and equitable balance. During the post-WWII era, the incomes of all segments of society benefited equally, but this has not been true since 1979. The number of homeless Americans remains stable, as does the number of shelter beds, but the top 1-2% of America's wealthiest have been experiencing dramatic gains in wealth. The potential consequences of these trends are the creation of a permanent underclass consisting of homeless youth without the means to improve and maintain their health, thereby increasing their chances of reentering the workforce and thus American society.