Outreach health services for street youth

Understanding Dermatologic Concerns Among Persons Experiencing Homelessness: A Scoping Review and Discussion for Improved Delivery of Care

There is a paucity of information surrounding dermatologic care for persons experiencing homelessness (PEH). This scoping review aims to map existing literature and provide a summary of the most common cutaneous manifestations among PEH, risk factors for dermatologic disease, describe any reported interventions, as well as identify research gaps for future studies. Search strategies developed for MEDLINE and hand searching yielded 486 articles. Out of the 486 articles screened, 93 articles met the inclusion criteria. The majority were cohort studies, cross-sectional studies, and case-control studies concentrated in North America and Europe. Excluding the pediatric population, the prevalence of dermatologic conditions ranged from 16.6% to 53.5%. Common skin conditions described in PEH were: acne, psoriasis, seborrheic dermatitis, atopic dermatitis, and lichen simplex chronicus. There were no studies comparing the extent or severity of these cutaneous diseases in PEH and the general population. PEH have a higher prevalence of skin infections and non-melanoma skin cancers. This scoping review has direct implications on public health interventions for PEH and highlights the need for evidence-based interventions to provide optimum and safe dermatologic healthcare for PEH. We propose several recommendations for improved care delivery, including addressing upstream factors and comorbidities impacting skin health, providing trauma informed care, reducing barriers to care, preventing and managing skin conditions, as well as including PEH in the planning and implementation of any proposed intervention.

Outreach with street-involved youth: a quantitative and qualitative review of the literature

Outreach workers meet with street-involved youth in their environment, and attempt to engage them in services vital to their well-being. The goal of this study is to conduct a systematic review of both the quantitative and qualitative research that explores outreach with street-involved youth. Using 16 outreach programs with quantitative information, our meta-analysis found that 63% of youth who are contacted through outreach later participate in the offered service. Our meta-synthesis of 31 qualitative articles on outreach uncovered 13 themes across 4 conceptual domains of interest. Themes pertaining to the therapeutic relationship, flexibility, and youth-centric programming had a large presence among the majority of the articles. Outreach with street-involved youth, when characterized through a strong bond between worker and youth, is an effective strategy for involving youth in agency services.

Homeless "squeegee kids": food insecurity and daily survival

Current knowledge about food insecurity in North America is largely based on research with low-income households. Much less is known about the food experiences of homeless people, a group who are particularly vulnerable to food insecurity. This study explored the food experiences of street youth, one of the fastest growing segments of the homeless population in Canada. To gain an in-depth understanding of food insecurity within the context of daily life, ethnographic research was undertaken with street youth at one inner-city drop-in centre in Toronto, Canada. Results of this study reveal that street youth's access to food was precarious amidst the instability and chaos of street life. The day-to-day lives of the street youth encountered in this study were characterized by a constant struggle to find safe, secure shelter, generate income, and obtain sufficient food. In this context, food was a precious commodity. Food access was inextricably linked to and contingent upon conditions of health, shelter, and income. Food access was precarious since everyday food sources purchased food and charitable food assistance were ultimately insecure. "Squeegeeing" (washing car windows), the primary source of income for youth in the study, was dependent on the weather, political and public will, and youth's physical health, and thus did not generate enough money to continuously meet basic food needs. Charitable food assistance was considered poor quality and was associated with food sickness. The often unsavoury atmosphere of charitable food programmes, their locations, capacity, and idiosyncratic rules, policies, and hours of operation also affected access. Findings from this study extend the current understanding of food insecurity to homeless youth and offer insight into current responses to hunger and homelessness.

Service use patterns of youth with, and at high risk for, HIV: a care typology

This paper uses confirmatory structural equation models to develop and test a theoretical model for understanding the service utilization history of 4679 youth who received services from 10 national HIV/AIDS demonstration models of youth-appropriate and youth-attractive services funded by the Special Projects of National Significance (SPNS) Program, HIV/AIDS Bureau, Health Resources and Services Administration. Although the projects differ from one another in the areas of emphasis in their service models, each is targeted to youth at high risk for HIV, or those youth who have already contracted HIV. Collectively, the projects represent a comprehensive adolescent HIV service model. This paper examines the characteristics of the services provided to young people ranging from outreach to intensive participation in medical treatment. Major typologies of service utilization are derived empirically through exploratory factor and cluster analysis methods. Confirmatory structural equation modeling methods are used to refine the exploratory results using a derivation and replication strategy and methods of statistical estimation appropriate for non-normally distributed service utilization indicators. The model hypothesizes that youth enter the service system through a general construct of connectedness to a comprehensive service model and through service-specific methods, primarily of outreach or emergency services. Estimates are made of the degree to which a comprehensive service model drives the services as opposed to specific service entry points.

Health and access to care: perspectives of homeless youth in Baltimore City, U.S.A

Homeless youth suffer from high rates of health problems, yet little is known about their perceptions of or context for their own health issues. In this study, a combination of qualitative techniques from participatory rural appraisal and rapid assessment procedures was used to investigate the perceptions of health needs of shelter-based youth in Baltimore, MD in the U.S.A. The most common youth-identified health problems included STDs, HIV/AIDS, pregnancy, depression, drug use and injuries. These correlate well with more objective health status data for the same youth. The youth spoke of environmental safety threats of violence and victimization by adults, as well as racism and sexism in their lives. Youth reported that trusted adult figures such as grandmothers are important sources of health advice. Many homeless youth from less than ideal family situations remain in contact with and continue to seek advice from parents and other family members. Health interventions with urban street youth need to acknowledge the primacy of the social context for these youth, as well as the reality of violence as a daily health threat.

Psychosocial histories, social environment, and HIV risk behaviors of injection and noninjection drug using homeless youths

Injection drug use is a common risk behavior for HIV infection among homeless, runaway and street youths. However, the psychosocial histories and current social environment of these youths are not well understood. The authors recruited 186 homeless, runaway and street youths using systematic street-based sampling methods, and assessed psychosocial histories, current daily activities, and sexual and drug-related risk behaviors using qualitative and quantitative techniques. Youths reported high lifetime rates of injection drug use (45%), recent drug and alcohol use (100%), and current homelessness (84%). Injection drug using youths were more likely than noninjection drug using youths to report traumatic psychosocial histories, including parental substance use and forced institutionalization, use of alcohol and other noninjection drugs, a history of survival sex, and the use of squats or abandoned buildings as shelter. These findings underscore the need for multifaceted service and prevention programs to address the varied needs of these high-risk youths.

A risk profile of street youth in northern California: implications for gender-specific human immunodeficiency virus prevention

PURPOSE

To assess human immunodeficiency virus (HIV) risk behaviors of street youth and to determine whether risk behaviors differ by gender or housing status.

METHODS

Using systematic street-based sampling in four Northern California cities, we recruited 429 street youth (mean age = 19.2 years). Participants completed a structured interview which was used to assess sexual and drug HIV risk behaviors.

RESULTS

The majority of youth were heterosexual (85%), white (77%), male (68%), and currently without any type of stable housing (75%). Although 60% of the sample had had vaginal sex in the past 30 days, only 44% used a condom the last time they had sex. About one-third (32%) of the sample reported ever injecting drugs, and almost all reported lifetime use of multiple drugs including D-lysergic acid diethylamide (96%), marijuana (90%), alcohol (81%), cocaine (70%), and speed (70%). Compared to males, females were equally likely to use injection and noninjection drugs, but were more likely to be sexually active (P < .001), were more likely to have been diagnosed with a sexually transmitted disease (P = .005), and were less likely to report consistent condom use (P = .003) or intent to use condoms consistently in the future (P = .005). Compared with those with stable housing, youth who were currently without such housing reported higher rates of injection, and other drug use; females without stable housing were less likely to have used condoms the last time they had vaginal intercourse.

CONCLUSION

The high level of HIV risk behavior in this street-based sample of youth, particularly females and youth without stable housing, suggests an urgent need for gender-specific prevention efforts and an increased range of housing options.

Health risks of homeless adolescents. Implications for holistic nursing

Although the exact number of homeless adolescents is unknown, it is estimated that this population may exceed 2 million. Literally living on the streets, homeless youth are at risk for a variety of physical, psychosocial, and spiritual health problems. Many engage in "survival sex," exchanging sexual favors for necessities of food, clothing, and shelter. Such risky sexual behaviors make them vulnerable to sexually transmitted diseases, including human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), and unintended pregnancies. Many have serious, diagnosable mental health problems, whereas others suffer various consequences of substance abuse. There is a need for comprehensive and holistic health care services, for which the majority of homeless youth have very limited access. Holistic nursing can provide creative interventions for thus vulnerable population.

Characteristics of troubled youths in a shelter

The purposes of this descriptive study were to: (a) describe the identifiable characteristics of a population of runaway youths; (b) describe certain aspects of the youths' current and past situations, such as alcohol and drug use/abuse and a history of physical or sexual abuse; (c) identify significant life events by means of the Coddington Life Events Scale (LES); and (d) examine possible ways in which health and mental health practitioners can best assist these youths and their families through times of crisis. A convenience sample of 78 runaway youths was drawn from an available population of 780 youths who were admitted to a runaway shelter, during the 7-month period of the study. The shelter is located in a semiurban community in north central Florida. Data collection instruments included the Structured Clinical Interview Instrument and the LES. These were administered to volunteer youth participants during the face-to-face interviews. Data from the current study support the assertion that many runaway youths live in abusive situations and are exposed to drugs and alcohol from a variety of sources. Furthermore, the high scores on the LES show insurmountable levels of stressful life events that occur at any given time. Researchers recommend that prevention programs focusing on the antecedents of runaway behavior be developed to prevent future runaway episodes.

Logical Responses to Youth Who Run Away From Home: Implications for Psychiatric Mental Health Nursing

1. Runaway youths do not fit into a typical profile; they are adolescents of every race, ethnic group, and religious orientation; they are representative of every socioeconomic status and geographic location in America. 2. Psychosocial events including physical and sexual abuse are common antecedents to runaway behaviors. 3. Implications for psychiatric mental health nursing practice include working with community programs focused on reducing runaway episodes; implementing preventive measures focused on strengthening parenting and problem-solving skills for reducing conflict with families with adolescent children; and promoting responsible sexuality through adequate and responsible sex education and counseling.

Sexual risk profiles of delinquent and homeless youths

Relatively little is know about the sexual behaviors of high-risk adolescents, such as delinquent and homeless youths. Having secured data from medical examinations, this study provides sexual risk profiles for a sample of delinquent (N = 245) and homeless (N = 160) youths in San Francisco, California. The study found several indicators of high-risk behaviors, such as high levels of STDs, trading sex for money or drugs, and unprotected sexual relations with multiple partners. The study suggests that communities provide better sex education and medical services to high-risk adolescents through multi-service health clinics, public health clinics, and street outreach.