ACR Health's Case Management Model for Homeless Youth

Introduction

It is difficult to pinpoint the exact number of homeless youths who emerge on the streets each year, but the number is likely between 1.5 and 2 million (Dworsky, 2010). For some of these youths, homelessness is a temporary episode; for others, it is an ongoing fight for survival. The ways in which young people end up on the streets are as diverse as they are: some run away — often fleeing abusive homes — or are forced out, which is how many pregnant or LGBTQ teenagers end up on the street. Others are homeless because they have aged out of the foster care system or out of juvenile detention (Dworsky, 2010).

The experiences homeless youths have on the streets are as varied as the reasons that brought them there. Understanding the backgrounds of homeless youths is crucial in order to identify the best ways to help them. This paper looks at the multifaceted needs of homeless youth and how ACR Health attempts to meet those needs. Some of the most basic tactics involve assessing whether any familial reconciliation is possible — though in many cases, no such resolution is in the youth's best interest. This paper explores how stability is created and maintained for these young people, and the type of goal-setting involved in helping them make the transition to stable adulthood.

The bulk of this project involved interviewing and shadowing the Director of Youth Housing at ACR Health, who was able to illuminate many of the obstacles ACR faces in helping homeless young people exit homelessness permanently, and to demonstrate through real-life examples how the organization navigates those challenges. This field research helped ground more theoretical perspectives on the subject in practical reality.

Agency Name and Description

ACR Health: AIDS Community Resources is the agency examined in this paper, studied both in person and through research. The mission of the organization is to provide health services to all people suffering from chronic diseases — regardless of age, gender, ethnicity, or income — with a focus on those affected by HIV/AIDS in the northern counties of New York State, including St. Lawrence, Oswego, and Oneida counties (ACR Health, 2018). In addition to serving people with HIV/AIDS, ACR also works with individuals managing diabetes, obesity, heart disease, drug addiction, mental illness, and asthma, with the ultimate goal of helping clients effectively manage their conditions so that positive health outcomes occur and are sustained over time.

Another pillar of ACR's work is guiding and empowering individuals to make better decisions that lead to improved health and safety outcomes (ACR Health, 2018). This is accomplished through STD and unwanted pregnancy prevention efforts and through a range of sexual health services offered to individuals. Ultimately, the organization endeavors to bolster the wellness of all who need support in their communities and to serve as a reliable resource for achieving that wellness (ACR Health, 2018).

As the Director of Youth Housing explained, many of the young people ACR works with come from homes and families that have perpetuated a legacy of neglect. Many of these youths do not know basic health behaviors — such as brushing their teeth twice a day — that help keep them healthy and ward off disease. "It may sound silly," the Director noted, "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 help bridge the gaps that their parents left during their development" (Personal Communication, February 13, 2018).

Principles and Goals of Case Management

Effective case management has long been associated with positive outcomes for homeless youth. In the current era, however, effective case management must incorporate an electronic component — particularly when working with young people (Bender et al., 2015). According to the Director of Youth Housing, the team at ACR's Youth Housing program does incorporate electronic case management, in part because teenagers often face logistical barriers that prevent them from attending in-person meetings, and because communicating via electronic technology is second nature to this population.

When funding allows, youths receive prepaid cell phones and are assigned a case manager who provides four electronic case management sessions every two weeks over a 12-week period. Case managers document how frequently youths engaged with their phones and responded to calls, emails, and texts. While youths generally needed consistent encouragement from case managers to respond, they rated electronic case management very positively overall. The Director noted that teens were most communicative through texting and expressed enthusiasm about the implications of these results for the future of case management practice.

Regarding the case management model ACR uses, the Director 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 coordinate services for them through a range of social service avenues. In these cases, it is enough to evaluate their needs, make appropriate referrals, and monitor the treatment they receive over time. Other youths require more from us, and that is when we incorporate more of the Clinical Case Management Model — useful because it centers on engaging the youths in regular therapeutic interventions such as psychotherapy and crisis interventions" (Personal Communication, February 13, 2018).

The Director described working with one homeless youth who was HIV-positive and engaged in self-harm behaviors such as cutting. This youth could not commit to stopping the self-harming even for a single day, explaining that the behavior was soothing and helped him feel calm. Given these circumstances, a sustained crisis intervention was necessary. The youth was admitted to the hospital for monitoring, where psychotherapists experienced with HIV/AIDS patients met with him until staff were confident he would not engage in further self-harm. This was achieved in part by connecting the youth with a broader team of social support resources — beyond just his case manager — so that he felt comprehensively supported.

As the Director emphasized, much of case management is highly individualized. Each teenager is paired with a case manager, and together they develop a self-sufficiency plan or individual action plan based on the youth's strengths and objectives (Dworsky, 2010). For some youths, a primary goal is earning a high school diploma; for others, it is finding stable employment or identifying a long-term career path. The case manager serves as a guide in helping the youth navigate the full range of available resources.

Three Components of Case Management

According to the Director of Youth Housing, the three core components of case management are: building trusting relationships, using evidence-based practice, and doing everything realistically possible to empower the client.

The first component — building trusting relationships — is foundational to working effectively and consistently with homeless youth. The National Association of Social Workers (NASW) has long asserted that a strong, therapeutic relationship between practitioner and client can have a tremendous impact on how well a case is managed and on the positive outcomes the client achieves. Trust develops once the case manager creates a safe environment in which the youth feels comfortable sharing their problems, fears, and goals. The case manager must convey empathy while putting the client at ease. Research has found that the more empathetic case managers are, the more likely their clients are to achieve positive outcomes and sustain lasting improvement (Lacay, 2016).

The second pillar — consistent reliance on evidence-based practice — is essential because homeless youths represent a specific population with specific yet diverse needs. For example, research by Johnson and colleagues found that for homeless teenagers with HIV/AIDS, stable housing and medical care alone were insufficient; therapeutic interventions supporting mental and emotional health were also necessary (2003). More recently, Mastropieri and associates found that treatment supporting spiritual development and coping can be a valuable resource for homeless youths, many of whom have experienced immense trauma (2015). Remaining current with relevant research findings allows case managers to offer greater value to this population.

The third component — empowering the client — is especially important in this line of work. As the Director explained, "many of these homeless youths have had their self-esteem shredded by their parents" (Personal Communication, February 15, 2018). Many of these teenagers, particularly those who identify as LGBTQ, have been told they are worthless, unclean, or otherwise subjected to abuse by parents or caregivers — a reality documented extensively in the scholarly literature (Ream & Forge, 2014). Empowering clients often begins with helping them rebuild self-esteem and a sense of self-worth.

References

ACR Health. (2018). ACR Health. Retrieved from

Bender, K., Schau, N., Begun, S., Haffejee, B., Barman-Adhikari, A., & Hathaway, J. (2015). Electronic case management with homeless youth. Evaluation and Program Planning, 50, 36–42.

Dworsky, A. (2010). Supporting homeless youth during the transition to adulthood: Housing-based independent living programs. The Prevention Researcher, 17(2), 17–21.

Johnson, R. L., Botwinick, G., Sell, R. L., Martinez, J., Siciliano, C., Friedman, L. B., ... & Bell, D. (2003). The utilization of treatment and case management services by HIV-infected youth. Journal of Adolescent Health, 33(2), 31–38.

Lacay, S. (2016, September 25). Breaking boundaries with empathy: How the therapeutic alliance can defy client/worker differences. Retrieved from http://www.socialworker.com/feature-articles/practice/Breaking_Boundaries_With_Empathy%3A_How_the_Therapeutic_Alliance_Can_Defy_Client-Worker_Differences/

Mastropieri, B., Schussel, L., Forbes, D., & Miller, L. (2015). Inner resources for survival: Integrating interpersonal psychotherapy with spiritual visualization with homeless youth. Journal of Religion and Health, 54(3), 903–921.

Miller, A. (2013, March 4). What is the role of the case worker or manager? Retrieved from https://careertrend.com/role-case-worker-manager-5063.html

NASW. (n.d.). Code of ethics. Retrieved from https://www.socialworkers.org/about/ethics/code-of-ethics

Ream, G. L., & Forge, N. R. (2014). Homeless lesbian, gay, bisexual, and transgender (LGBT) youth in New York City: Insights from the field. Child Welfare, 93(2), 7.

Slesnick, N., Prestopnik, J. L., Meyers, R. J., & Glassman, M. (2007). Treatment outcome for street-living, homeless youth. Addictive Behaviors, 32(6), 1237–1251.