1. Homeless Youth: Reducing the Barriers to Care

4. Homelessness Defined
The term "homeless children and youths” means individuals who lack a fixed, regular, and adequate nighttime residence
This includes children and youths who are
living in motels, hotels, trailer parks, or camping grounds due to the lack of alternative adequate accommodations;
living in cars, parks, public spaces, abandoned buildings, substandard housing, bus or train stations, similar settings, or other public or private places not designed for or ordinarily used as a regular sleeping accommodation for human beings;
living in emergency or transitional shelters;
abandoned in hospitals;
awaiting foster care placement;
“doubled up” due to loss of housing, economic hardship, or a similar reason. (DHHS Definition)
The definition is broad and includes children and youth who are living in a range of settings and circumstances. Given its breadth, there are many children and youth who fit the definition of “homeless” but who might not consider themselves homeless. Of course, they might also not want to divulge this information because of feelings of shame.
<<A.E.: We’ve done a good job of making the poor feel ashamed of their state, but it’s us who should be ashamed for allowing people – children – to lack basic necessities in the wealthiest state in the country in the history of history. It’s shameful – and we should act to address this!>>
**Therefore, simply asking a young person if they are experiencing homelessness might not get an accurate answer; deeper questions may be necessary – e.g., about where they’ve stayed, for how long, ….

5. Prevalence of Youth Homelessness Nationally
5 -7.7% of youth experience homelessness each yr, which means 1.6 million youth between yrs and 2.5 million between
Local community programs, funded by the Runaway and Homeless Youth Act (HHS) and administered by DHHS, served over 786,600 homeless and runaway youth in 2008.
DHHS reported that 5,100 homeless youth were turned away from shelter and housing in 2008 due to lack of bed spaces
(Source: National Alliance to End Homelessness)
Note imperfect nature – and inaccurate results – of homeless censuses. Such counts miss people in many of the areas included in the definition. In particular…
People who are “doubled up” are often not counted because they’re not seeking services or shelter.
People staying in abandoned buildings or other locations out of public sight – so as to avoid citation or arrest for so-called “nuisance crimes” – won’t be counted.
Moreover, because there is a lack of shelters and service providers for homeless youth, only a small number or those in need are able to access services, which means that only a small number are able to be counted at service provider sites. I.e., the lack of shelter and services for homeless youth suppresses the number of youth who are counted.
While imperfect, the closest comparison would be between the 640 youth identified in 2011 and the 426 identified in 2009 – a 150% increase.
<<A.E.: If you want to make the problem look manageable, such counts are great. If you want to really understand and address the problem, such counts are pretty worthless.>>

6. Prevalence of Children & Youth Homelessness in Maryland
According to the National Center on Family Homelessness:
Maryland ranks 18th in the Nation in child homelessness(0-18 y.o.)
In 2010, there were an estimated 12,810 children/youth experiencing homelessness in Maryland. (This number does include the 844 homeless, unaccompanied youth)
Of the 131,000 children/youth living in poverty in Md., one out of every 10 (10%) are homeless.

7. Prevalence of Youth Homelessness in Baltimore
2007: the Johns Hopkins School of Public Health and the Baltimore Homeless Youth Initiative conducted a one-day census which counted 272 homeless and unstably housed young people. 
2009: the homeless youth count identified 781 young people (ages 10-24) who were homeless or unstably housed.  Of these, 426 were unaccompanied by parents or guardians.  (The 2009 number represents a 287% increase over 2007.)
In January 2011, the homeless youth count of young people between the ages of 13 and 25 identified 640 unaccompanied youth in Baltimore City.

8. Causes of Homelessness
Lack of livable incomes (i.e., poverty)
Lack of housing affordable to households with very low incomes
Lack of health and supportive services
Lara
Other people add in..
The same factors that cause adult homelessness lead to homelessness among youth. Fundamentally, homelessness is caused by…
Poverty
Lack of Affordable Housing
Lack of Health and Supportive Services
<<A.E.: Also war, racism, sexism,… – all of which are a result of capitalism and human alienation.>>

9. Causes of Homelessness Cont’…
Youth homelessness is largely a reflection of family breakdown. Youth become homeless for varying reasons, including:
leaving home because of physical and/or sexual abuse;
being abandoned by their parents or guardians – e.g., because of non-acceptance of the youth’s gender identity or sexual orientation; parents incarceration, parents substance abuse, parents mental health problems
being emancipated – e.g., because of teen pregnancy;
exiting Foster Care and/or the Juvenile Correction system.
Lara
Other people add in..
Although family conflict plays a role in adult homelessness, the nexus is more critical for youth because they are, by virtue of their developmental state in life, still largely financially, emotionally, and, depending on their age, legally dependent upon their families.
Some youth have MH issues that have not been treated or diagnosed which could also play a part in this.

10. Personal Experiences of Youth Homelessness
Luther
Shawn
Other stories…
“On Our Own” Short Film

11. Realities and Consequences of Youth Homelessness
Homelessness is bad for one’s health and well-being . It’s especially dangerous for young people who do not have familial support. Unaccompanied homeless youth are at a higher risk:
Physical health problems
Physical and sexual assault
Severe emotional stress - including anxiety disorders, depression, posttraumatic stress disorder (PTSD), and suicide
Substance abuse
Prostitution – i.e., “survival sex”: Data indicates that within 72 hours of hitting the streets, 1 out of every 3 runaways will be forced to engage in survival sex in order to meet their basic needs for food and shelter (National Runaway Switchboard).
Luther: Realities of youth homelessness – and what it takes to survive.

12. Realities and Consequences of Youth Homelessness, cont’…
What is it like to be on the street?
Unsafe, scary, and uncomfortable
Where do youth sleep?
Wherever they feel mostly comfortable and/or safe - it could be a friend’s or family members house, shelter, bus stop, park bench, alley, etc.
Where and what do they eat?
They eat whatever they can get their hands on unless health problems only allow them to eat certain things. Youth go to friends and family houses, soup kitchens or wherever they feel its safe, comfortable and welcoming to eat.
What do they look like?
There’s really no way to tell who’s homeless. While some youth might look distressed in dirty clothes and with poor hygiene, others will be clean and fresh as anyone who’s housed. you really have to talk and listen to there story. They might have some holes in there story which could also mean they are homeless.
Homeless young people also experience barriers to education and employment.
Shawn

13. Homeless Youth have a Right to an Equal Education
Homeless youth can:
Enroll immediately (without records, school uniforms or fees or a parents involvement)
Stay at their school of origin even if they are moving from place to place and receive free transportation to this school, or
Transfer to the school which is closest to their current location
Receive free school meals and uniforms
Access all school activities without paying fees
Apply for financial aid for college without sharing information about a parent
Lara

14. What do Homeless Youth Want and Need from Providers?
Rule #1: Do not “ask are you homeless?”
Reason: They might not know that they are homeless or they might be scared or ashamed of it.
Rule #2: Listen deeply - take the time to process what youth really are saying.
Reason: Without really listening it’s easy to miss what youth are really saying. Also, youth want help and want to know someone cares and someone is trying to help them.
Rule #3: Expect that they may not let you in
Reason: Homeless youth have often been hurt many times and they haven’t learned that they can trust people.
Rule #4: Know your boundaries and stick to them
Reason: Some youth are looking for parents, sisters, aunties, etc. If you swoop in to help them more than you should, you’re setting them up to be hurt because you can’t keep that up.

15. Challenges of Serving Youth Experiencing Homelessness
Given the realities, might want to talk about challenges…
Which then could lead into discussion of SB72 in particular.

16. SB 72: The Challenges
Obtaining Medical Consent. In order to provide routine primary and preventative health care to minors, a clinician must receive permission from a parent or legal guardian.
Access to Care due to perceived cost, lack of trust by youth, institutional/system barriers, transportation, lack of knowledge by youth regarding resources in the community.
Challenges: where to find youth, many are doubled up not in shelters
Because homeless youth move from place to place and can disappear quickly, it is critical that certified health professionals address as many needs as possible while they have the opportunity.
When a legal guardian cannot be reached, medical practitioners have been unable to provide services (unless it is an emergency).

17. The Solution(s)
Create a Health Center that addresses the unique needs of homeless children/youth
CHANGE THE LAW

18. Pediatric & Adolescent Clinic at Health Care for the Homeless, Inc.

20. SB 72: The Legal Solution
The new law allows youth who are living separate from their parent/guardian and providing self-support to consent to their own medical treatment.
This allows unaccompanied youth experiencing homelessness to seek medical treatment for chronic and acute health conditions such as asthma, the flu or a sprained ankle.
The new law also extends liability protections - for lack of parental consent only - to the clinicians who treat them.
Providing needed medical care to homeless youth is a critical step toward ending their homelessness. Given the ability to provide comprehensive medical care, providers at HCH and elsewhere in the community now have more tools at their disposal to engage youth with the hope of helping them treat their health conditions and end their homelessness.

25. SB 72: Lessons Learned
Senate Bill 72 unanimously passed both houses in the Maryland General Assembly and was signed into law by Governor O’Malley on May 2. The new law became effective on October 1.
The success demonstrated…
Importance of Perseverance: It took several years.
Importance of Legislative Champions: Both Ds and Rs
Importance of Committed Partners: MedChi, Maryland Chapter of the American Academy of Pediatrics
Importance of Provider and Consumer Participation in Policy: Provides expertise, and puts a face on the real experiences, challenges and impact

26. The Work Ahead
Raise awareness about SB72 – and about youth homelessness generally
Support the Maryland Unaccompanied Youth Act and other initiatives to increase services (e.g., youth shelters, more effective child welfare policies) and reduce barriers for vulnerable youth
Advocate for systemic change to address the causes of homelessness – for people young and old:
Support living wages and adequate public benefits
Support the development of housing affordable to households with extremely low incomes
Support health care and supportive services for low income and otherwise vulnerable individuals.
Among the “other initiatives” you might mention HB103, which would have allowed young people aging out of the foster care system to qualify for Medicaid until age 26 – essentially establishing parity with the ACA provision for children on their parents’ health insurance.
The ACA will – beginning in 2014 – provide public health insurance coverage (through Medicaid expansion) to everyone at or below 138% of FPL. This means that young people who are poor won’t lose their health insurance when they turn 19. People above 138% of FPL will receive public assistance to purchase health insurance in the private market. <<E.A. This maintains health care as a commodity – not a right. And while it expands coverage, it also further entrenches the for-profit health insurance industry.>>

27. Health Care and Housing should be Fundamental rights

28. Youth Empowered Society (YES)
Grew out of the Baltimore Homeless Youth Initiative (BHYI)
Specifically, the BHYI’s Youth Leaders were the driving force behind this drop-in center that was planned to be one-stop shop that was centrally located, easily accessible by public transportation, open in the evenings, and, most importantly, staffed by young adults with experiences of homelessness.
Planning, fundraising, support from OSI, and endless group decision-making sessions eventually led to YES
Founded and run by formerly homeless youth and their allies, the Youth Empowered Society (YES) works to end youth homelessness in Baltimore by supporting formerly homeless youth to become leaders in our community and by providing vital, direct services to homeless youth.
Shawn & Lara

29. YES Drop-In Center

30. YES Drop-In Center
The YES Drop-In Center is a safe space for youth, who are homeless or at-risk of homelessness and between ages 14-25, to get basic needs met and establish supportive relationships that help them make and sustain connections to long-term resources and opportunities.
Our vision is that all Baltimore youth will easily access the resources they need to achieve stable housing and become healthy, successful adults.
The Drop-In Center opened October 3rd and is now open Mon-Thurs 3-8pm to receive youth.
Currently we provide: clothing, hygiene products, food, transportation assistance, laundry and storage services, assistance obtaining identification, appts with providers…
Luther & Lara
Shawn: We are using a peer counselors to welcome youth in to the center. Peer counselors are youth and young adults who have been through homelessness and have overcome the hardships and now help other youth get to where we are now. (Source of hope)

31. The (Few) Other Resources in Baltimore for Homeless Youth
Rose Street and Loving Arms Youth Shelters
-8 beds each
City Steps/AIRS Transitional and Permanent Housing
-7 Transitional beds for single year olds
-12 Transitional beds for women with children, 18-24
-43 Permanent housing unites for single year olds
-Additional scattered site permanent housing units for year olds with disabilities
Maryland Foster Youth Resource Center
-Resources center and alternative transitional housing program for transitioning and former foster youth
Lara

32. What Else Needs to Exist?
More shelter beds for youth under 18
A shelter for youth 18-24, with or without children
Shelters that offer therapy services
More one-stop-shop centers like YES 
More employment opportunities in fields that youth are interested in
More affordable housing
More permanent supportive housing
Supportive services to help youth stay housed
Shawn

33. How Can we Bring About these Changes?
The Journey Home for Youth: Updating Baltimore’s 10 Year Plan to End Homelessness
Maryland Unaccompanied Homeless Youth Act
Creates an Office of Unaccompanied Youth Housing within DHCD charges to provide or contract for:
Street Outreach Services,
Drop-In Programs,
Youth Shelters and Transitional Living Programs,
Permanent Housing &
Data Collection.
In effect it establishes a right to housing for homeless youth 14-24
Strategy will likely be to ask for funding for pilot programs first
Lara

34. Contact Information
Lisa Stambolis, CPNP 421 Fallsway, Baltimore, MD Lara Law, Shawn Toyer & Luther Thompson Youth Empowered Society – YES Drop-In Center 2315 N. Charles, 1st Fl, Baltimore, MD

35. No Relevant Financial Relationships with Commercial Interests
Disclosures
No Relevant Financial Relationships with Commercial Interests