Transitional-age youth homelessness and lack of access to health care is an underrecognized issue in NEPA. In this article I am specifically considering 14-19 year olds.
The state of youth homelessness:
The Pennsylvania Department of Education reports that at least 32,666 PA students were affected by homelessness during the 2020-21 school year.
In Scranton, 125 students were identified as homeless by the public school district between 2019 and 2020. Actual numbers may be higher and according to state and national trends during the pandemic.
The NEPA Youth Shelter (NYS) addresses youth homelessness by providing a safe haven to approximately 40-70 youth every weeknight. The mission is to provide quality emergency shelter and related services to unaccompanied youth ages 14 through high school graduation from all counties in NEPA. As a medical student volunteer, I have observed how the shelter provides a safe space for youth of all backgrounds and identities. Youth receive nutritious meals and have access to a food pantry, leisure activities, clothing donation boutique, hygiene products, and mental health services. What is desperately need are physical health services.
Several other medical students and I conducted a Youth Health Needs survey at the shelter last year. Our major findings were:
According to shelter staff, many of the youth face barriers to accessing to health care. Consequently they have put off health issues as severe as bone breaks and injuries requiring stitches because it was either impossible or inconvenient to get care.
When asked about their past experiences getting health care, several youth said they had not felt safe or comfortable talking to the doctor or had difficulty understanding them.
The majority of those surveyed said that if a doctor were present at the shelter, they would want to talk to them about physical health, sexual health, drug/alcohol use, or another topic.
These findings are consistent with other research studies, which have found that youth with a history of unstable housing are more likely to have problems accessing health care.
Access to health care – both preventative and acute –is especially important in adolescence because:
Injuries, both intentional and unintentional, disproportionately affect adolescents and young adults.
Tobacco and alcohol use may emerge in adolescence as may excessive sedentary behavior, posing major risks for substance use disorders, type two diabetes, and cardiovascular disease, respectively.4 It is imperative that adolescents have regular visits with a health care provider to identify, discuss, and plan to modify these behaviors, if present, in order to avoid health consequences in adulthood.
Mental illnesses commonly emerge during adolescence. Transitional-age youth with a history of unstable housing are more likely to develop mental illnesses and/or have PTSD. NYS Youth can access therapy in a private, de-stigmatizing environment with the shelter’s mental health therapist; however, collaboration between the therapist and a medical professional would augment services.
We identified two community health care clinics that were willing to staff the shelter with one of their providers a designated number of times a month and shelter staff identified the perfect space for a clinic. However, we encountered a logistical obstacle: in order for providers to bill for health care services provided at NYS, youth would need to obtain parental consent. A take-home parental consent form presents two challenges:
Many NYS youth lack parents/guardians who are present and whom they feel comfortable asking for health consent.
Research has found that adolescents are deterred from seeking health care due to the fear of their parents being informed about sensitive issues, such as mental health, substance use, and sexual behaviors. In one US study, adolescents cited not wanting their parents to find out as the primary reason for forgoing health care.
My colleagues at Geisinger and I have not yet found a workable solution to bring health care services to NYS. I spoke with another Pennsylvania shelter serving teens and young adults and learned that they too have experienced difficulties obtaining consent for youth physicals when a guardian is not contactable. A state-wide coalition to identify solutions may be necessary in the long term. However, in the short term, I continue to work with my colleagues and shelter staff to make health care services available at NYS.
We have rich healthcare resources in the region. We need to bring these resources to the individuals who need it most in a place that is already accessible to them. If you are a health care professional or community members who is interested in joining this effort, please reach out to me.
Contact: Sophie Roe, M.D. Candidate sroe@som.geisinger.edu
1. https://www.altoonamirror.com/news/local-news/2022/11/homeless-students-a-concern-in-region/#:~:text=Statewide%2C%20at%20least%2032%2C666%20students%20were%20affected%20by,term%20homeless%20encompasses%20a%20wide%20range%20of%20circumstances.
2. https://www.nepayouthshelter.org/about-us
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5832967/#__ffn_sectitle
5. https://onlinelibrary.wiley.com/doi/10.1111/phn.12727
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5832967/#!po=70.9302