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‘A Moment’ to Make a Difference

November 3, 2016

image of a homeless youth sitting against a red brick building
"Trust is gone" for homeless youth who show up in a health clinic, experts say.
Staff have minutes to help. And that's when on-site behavioral health specialists --
case managers, social workers, substance counselors -- can play a crucial role

​​​​​​​​​​​For homeless young people, the decision to seek medical help can be desperate. But it's also a rare chance to get them off the street – and the odds of success rise when a clinic has a behavioral health specialist immediately available to take them in hand, experts said in a recent national web conference.

The U.S. Department of Housing and Urban Development reports that people 24 years of age and younger make up about one-third of the homeless population, said Kent Forde of HRSA's Bureau of Primary Health Care.

Estimates of the number of homeless kids​ in the U.S. each year range from 500,000 to as many as 2.8 million.

Health Centers provided care to some 1.1 million homeless patients in 2014, BPHC's Forde reported, in an August panel presentation for the HRSA-SAMHSA Center for Integrated Health Solutions. But while there has been a 47 percent decline in homelessness among veterans since 2010, for example, young people continue to represent a formidable population.

"We see day in and day out that an individual's physical health is impacted by various social, mental health and other environmental factors," said Juli Hishida, with the National Health Care for the Homeless Council.

Ending youth homelessness by 2020 is one of four goals of the U.S. Interagency Council on Homelessness, a consortium of 19 federal agencies chaired this year by HHS Secretary Sylvia Burwell – and health clinic intakes open a tenuous window of opportunity.

Having behavioral counselors on site, working beside primary providers, in one place, in that critical moment, is far more effective than referring homeless patients to an off-site appointment days or weeks away, experts said.

Pictured left to right: HRSA's Kent Forde; Juli Hishida of the healthcare for the homelesscouncil; Susan Marie, Portland, Ore; Seattle's Dr. Leslie Walker-Harding​, now at Penn State.
In The Moment: (From left) HRSA's Kent Forde; Juli Hishida of the healthcare for the homeless
council; Susan Marie, Portland, Ore; Seattle's Dr. Leslie Walker-Harding​, now at Penn State.
On-the-spot behavioral health services in Community Health Centers, free clinics and other
primary care venues can represent the last chance some kids get.

"We've had much, much more success by bringing them (counselors) in-house," said Susan Marie of the HRSA-supported Old Town Clinic in Portland, Oregon.  

With addiction and Post Traumatic Stress Disorder services as cornerstones, mental health specialists at Old Town act as "lifeguards" – who "check-in, take the temperature of all the different (primary care) teams" and provide crisis intervention on the spot when needed.

Care "has to be incredibly fluid and flexible, and that is where we can really make a difference in people's outcomes," Marie said. "It's being there in the moment -- (when) they're ready to say yes -- and connecting … that really makes a difference."  

Homeless youth surveyed in Seattle, W​ash., appreciated providers who "take our lives into account," and preferred a classic, one-site "medical home," said Dr. Leslie Walker-Harding, who worked in the city's Country Doctor Free Teen Clinic – a dedicated youth haven offering drug treatment, meals and clothing, along with primary care.

The fact that a homeless kid seeks out a health care facility at all is significant in itself, she said.

"Their trust is gone by the time they are walking through that door," Walker-Harding said. "There is something critical that has brought them to that moment."

And in that moment is a chance to save a life.

Watch the webcast.

Date Last Reviewed:  July 2017