Runaway Youth

Recent estimates indicate that there are over 1 million runaway and homeless youth and young adults (RHY) in the United States (US). Exposure to trauma, violence, and substance abuse, coupled with a lack of community support services, puts homeless youth at high risk of being exploited and trafficked. Although access to safe housing and supportive services such as physical and mental healthcare is an effective response to youth’s vulnerability towards being trafficked, the number of youth experiencing homelessness exceeds the capacity of available housing resources in most US communities. We undertake a RHY-informed, systematic, and data-driven approach to project the collective capacity required by service providers to adequately meet the needs of RHY in New York City, including those most at risk of being trafficked. Our approach involves an integer linear programming model that extends the multiple multidimensional knap-sack problem and is informed by partnerships with key stakeholders. The mathematical model allows for time-dependent allocation and capacity expansion, while incorporating stochastic youth arrivals and length of stays, services provided in a periodic fashion, and service delivery time windows. Our RHY and service provider-centered approach is an important step toward meeting the actual, rather than presumed, survival needs of vulnerable youth.

Access to healthcare services is critical for youth experiencing homelessness (YEH) given their high risk of experiencing adverse physical and mental health outcomes. Previous studies have identified factors that impact YEH’s access to healthcare services from the perspective of YEH, but less is known from the perspective of providers. The purpose of this study was to examine providers’ experiences and perceptions of the barriers and facilitators that impact YEH’s access to healthcare. Semi-structured interviews were conducted with 17 healthcare and social service providers in Houston, Texas. Drawing on constructs from healthcare access frameworks, findings were categorized into barrier-and facilitator-related themes that reflect five dimensions of healthcare access: approachability, acceptability, accommodation, affordability, and adequacy. The most commonly reported barrier was the high-barrier healthcare service delivery system (e.g., numerous documentation requirements, multi-step process) that YEH had to navigate in order to access healthcare services, followed by the limited availability of free and low-cost healthcare services. The most commonly reported facilitator was building interagency relationships that helped streamline the referral process and provided direct organizational contacts that could be called upon when YEH need assistance. This was followed by offering healthcare navigation assistance (e.g., teaching YEH how to identify healthcare services online) and accompanying YEH to appointments, which better ensured YEH’s access to care. Collectively, study findings indicate that the complex way in which healthcare services are currently organized and delivered fails to adequately accommodate YEH, who need low-threshold access to youth-centered healthcare services. Gaps in YEH’s access to healthcare services can be narrowed using a combination of administrative strategies and research efforts. These include implementing policies, programs, and practices that incorporate trauma-informed principles in YEH-serving organizations; establishing interagency collaborations to better facilitate the service connection process; and developing and evaluating patient navigator programs designed to increase YEH’s access to healthcare service.

"BACKGROUND AND OBJECTIVES: Runaway youth and homeless youth are at risk for adverse mental abstract health outcomes. These 2 populations are frequently pooled together in both research and interventions yet may have unique health needs. We sought to assess differences in mental health outcomes among these populations.
METHODS: We conducted a secondary data analysis of ninth- and 11th-graders in the 2016 Minnesota Student Survey (n = 68 785). We categorized youth into 4 subgroups based on housing status in the previous year: (1) unaccompanied homeless youth (0.5%), (2) runaway youth (4%), (3) youth who had both run away and been homeless (0.6%), and (4) stably housed youth (95%). We performed multivariable logistic regression to compare 4 mental health outcomes (self-injury, suicidal ideation, suicide attempts, and depressive symptoms) across groups, controlling for demographics and abuse history. RESULTS: Unstably housed youth had poorer mental health outcomes when compared with their stably housed peers (P, .05). For example, 11% of homeless youth, 20% of runaways, and 33% of youth who had experienced both had attempted suicide in the previous year compared with 2% of stably housed youth (adjusted odds ratios 2.4, 4.9, and 7.1, respectively). Other outcomes showed a similar pattern.
CONCLUSIONS: Our findings suggest that runaway and homeless youth represent unique populations with high levels of mental health needs who would benefit from targeted clinical and community interventions. Pediatric clinicians represent one potential point of screening and intervention."

"Although it is well established that youths with unstable housing face increased health risks compared with peers with stable housing, there is considerable heterogeneity in youths’ experiences of housing instability, with implications for health, clinical practice, and policy. For instance, adolescents who are homeless with their families may have unique health needs compared with those who are unaccompanied, and youths who run away may be at particularly high risk for poor health outcomes. Given that annual preventive visits are recommended for all adolescents, they may represent an opportunity to explore housing status and address health needs of youth facing housing instability. To inform clinical practice and interventions, the authors sought to compare preventive health care utilization among subgroups of youth who have run away, experienced homelessness, or been stably housed.
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