JOURNAL OF ADOLESCENT HEALTH 1991;12:555-560
GARY L. YATIGS, M.A.,
B.C.C.,
A.VON SWOFPORD,
AND RICHARD
B.A.,
JULIA
PENN
Runaway and homeless young people generally do not seek help unless they are in a severe personal crisis. IFor the past 7 years, t e Division of Adolescent icine, Childrens Hospital of Los Angeles, has learned a good dea.1about bow to intervene effectively with these youths and divert them from high-risk behaviors such as prostitution and drug abuse. The program model we have developed has five major components: 1) networking and consolidation, 2) outreach, 3) short-term crisis sheiter, 4 comprehensive medical and psychosocial care, and 5) long-term shelter and case management. Our approach has been collaborative; we subcontract a substantial portion of the work to other youth agencies in the community in order to build and strengthen the network of existing services. In the process, we have moved steadily closer to developing a comprehensive system of care for homeless strecc youth throughout Los Angeles County. Where programs previously ope:id& in klative isolation, representatives from 40 private and public agencies now meet regularly at Childrens Hospital of Los Angeles to discuss ways to improve services. Systematized data collection has helped agencies understand how they can work together and has prompted additional funding for needed services. KEYWORDS:
Momelessyouth Runaway youth Community services Case management Outreach From tkc Division of Adolescent Medicine KXY., J,P., A.S., R.G.M.1, Childrens Hospital of Las Angeles, and the Departments of Pediatrics (G.L.Y., R.G.M.) and MedicLe (R.G.lt:J, University of Soutkpm California, Sckool of Medicine, Los Angek ,i, California. Address reprint requests to: Gary L. Yat’es, ML., M.F.C.C., Division of Adolescent Medicine, Childrens Hospital of Los Angeles, P.0. Box 54700, Los Angeles, CA 90054. Manuscript awpted November 20, 1990.
IBGE,
Ph.D.,
Hospital of Los Angeles has a Wyear tradition of community service. Founded by a grou of charitable women, our first hospital consisted of 4 beds in a converted Zstory frame house. From those modest beginnings, the hospital has grown to a 33P-bed facility situated on a 9-acre campus. Whereas the hospital has changed and grown dramatically over the course of its history, its commitrAw?nt to community service has continued to underpin its mission. As in the past, the hospital is a vital resource to the community it serves by providing necessary medical care to children from financially needy families. Our sommitment to community service has intensified as the neighborhood around the hospital has changed. The Hollywood/Wilshire area of Los Angeles has a population of 415,913, with 41% having incomes below 200% of the poverty level. The area has become an entry point for immigrants from around the world; more than 30 languages are spoken by students at Hollywood High School. Disturbingly, our area has also become a focal point for troubled young people, who gravitate to Hollywood from all over the country. Drug use and prostitution are endemic to the areas where they congregate along Hollywood and Santa Monica Boulevards and on the Sunset Strip. Many of these young peop1.e have r;m from. homes where they were victims of abuse or neglect. They are hurt, alienated, and distrustful of traditional health care agencies. They are clearly medically at risk, but their neecis extend beyond mere hea. th care. Without proper intervention, they will become the next generation of adult homeless. Since July 1982 the Division of Adolescent Medicine, Childrens Hospital of Los Angeles, has Childrens
G Society Par Adole: cent Medicine, 1991 Published by Elsevier Science Publishing Cc,., Inc., 655 Avenue of the Americas, New York, NY ItYIlO
555 1054-139x/91/$3.50
556
YATES EI- AL.
worked to improve services for street youth in the .Hollywood area through our High Risk Youth Program. This effort was begun with funding from the Rob& Wood Johnson Foundation as part of a national program to pilot consolidated health services for high-risk young people. Our success in reaching chronic street kids, previously thought unreachable, has attracted both time-limited government and private funds. As a result, we have been able to expand our services significantly. Our approach has been collaborative, as we subcontract a substantial portion of the work to &her agencies serving youth in the community. This both builds and strengthens the network of existing services.
The Problem California has become a popular haven for homeless street youth. It has a large population (alea.ost 10% of the entire nation), warm weather, numerous beaches, and a reputation for being a “cool place.” Nevertheless, researchers, service providers, and public agencies alike find it hard even to estimate the number of these youths in the state. A report published in 1985 suggested that the annual number of runaway or homeless youths in California ranged from 12,700 to 128,ooOand concluded that there was no reliable basis for arriving at an accurate number (1). In 1981, the United Way Planning Council sponsorea a study of Los hgeles County. The resulting report e&mated that there were 10,000 runaways in the county at any given moment, with the number swelling to 20,000 during the summer m0nth.s of July and August (2). 3’he report stressed that the figures were estimates and advised caution in interpreting them because fJf the impossibility of accurately esthidlg the t@al runaway population. In 1985, researchersat the Universityof California at Los A.n@ts School of SocialWelfare surveyed 48 members of the runaway and homeless youth services community in Los Angeles who had been identified as experts in the field (3). The researchers found that the exact number of youths needing services could not be determined. They also found that in recent years the runaway population in Los Angeles County has become younger, more ethnically varied, and more emotionally disturbed; and that these youth are coming from highIy dysfunctional families. The multiple health and medical needs of homeless street youth are clear from an analysisof a single
JOURNAL OF ADOLESCENT HEALTH Vol. 12, No. 7
year’s data (1985) from the medical clinic operated for this population by the Division of Adolescent Medicine, Childrens Hospital of Los Angeles. Of the homeless youths seen by the clinic, 85% were diagnosed as depressed, 9% were diagnosed as actively suicidal, 20% were diagnosed as having previously attempted suicide, and 18% were suffering from other severe mental health problems, e.g., behavior, personality, or thought disorders. Medical diagnoses such as cardiac arrhythmia, hepatitis, pneumonia, renal failure, and generalized adenopathy occurred significantly more often among runaway and homeless youths than among those youths who were living at home (4). These increased health problems were associated with higher rates of ‘high-risk behaviors. More than one-half (52%) of thtcse street youths were diagnosed as abusing drugs ($ith 35% engaged in intravenous drug use), and 26S’admitted to involvement in prostitution. Because this information was acquired from an initial interview with a physician, it is reasonable to assume that these reports are actually underestimates of high-risk behaviors (4).
System Design and Operation Our development of a system of care for runaway/ homeless youth builds on the success of our High Risk Youth Program. Over the paot 7 years, we have learned a good deal about how to intervene effectively with street youths and divert them from highrisk behaviors such as prostitution and drug abuse. The program model we have developed has five major components: 1) “networking and consolidation, 2) outreach, 3) short-term crisis shelter, 4) comprehensive medical and psychosocial care, and 5) longterm shelter and case management.
Nehworking and Consolidation All too often, socialservice agencies focus their energies on their own activitiesand fail to communicate effectivelywith one another. The gap between public and private agenciescan be particularlywide. For example, there is frequentlya lackof communication between youth agencies and local law enforcement, fueled by mutual distrust. When this happens, young people in need can “fall through the cracks” and fail to receive the help they need. A grant from the CaliforniaState Officeof Criminal Justice Planningunder the CaliforniaHomeless
November1991
Youth Act of 1985 allowed us to organize more than 40 agert&s operating in Los Angeles County into a Coordinating Council for Homeless Youth Services. The CounciI aeets at Childmns Hospital of Los Angeles on B quarterly basis and provides input and advice concerning program design, function, and direction. It .also serves to identify gaps and overlaps in services for runaway and homeless youth in the Hollywood/Wilshire area.
Runaway and homeless young people will generally not seek help for themselves unless they are in the middle of a severe personal crisis. In order to contact them before crises arise, our collaborating agencies use a var:iety of outreach strategies. Street outreach workers go to areas where street kids congregate and give out cards with the phone numbers and addresses of our clinic and other local programs. Agencies operate hotlines so they are accessible to young people who are unable to visit them. Agencies also operate drop-in shelters where clothing, food, and bus tokens are distributed.They also offer criss counseling, showers, and storage space. To increase the scope of efforts to contact homelesi youth, we have developed subcontracts with several existing outreach agencies in Los Angeles County. The purpose of these contacts is to provide tkese agencies (Angels Flight; Project Warn-Gay and Lesbian Community Services Center; Hollywood YMCA; Los Angeles (LA) Youth Network; Teen Canteen) with additional resources so that more young people can be contacted and referred to available services. TQ intensify collaboration among butreach agencies, we have convened a monthly meeting of outreach staff at Childrens Hospital of Los Angeles. Also, to systematize the prevention message given to street youth, we have provided a standardized training to all outreach agencies. Laa:r enforcement in Los Angeles CoTtinty plays a critical role in the system of care bv locating youths and trarsporting them to emergericy shelter. Under current statures, law enforcement can hold youths in detention while attempting to contact parents or guardians. Out-of-county youths may be held for 72 hours, whereas Iocal residents may be held up to 24 hours. Standard operating procedure for law enforcement in processing runaway and homeless youths is to transport youths to the local station, run “wants and warrants” checks on them, try to contact their
LOSANGELESSY§TFMOF CARE
557
parents, and then transport the youths to an open Probation Department Status Offender Detention Alternative(SODA) bed in a temporary foster home setting. Unfortunately, the SODA foster families can provide only limited services. They are often not trained to deal effectively with the problems of runaway and homeless adolescents and provide no structured daytime counseling or case management services. As a result, 45% of the youths served leave the program within a iew days. Not only do many youths leave the program, the paperwork associated with getting a youth into a SODA bed can take law enforcement officers several hours. In an attempt to reduce this processing time yet still help runaway youth, we have worked closely with the Hollywood Division of the Los Angeles Police Department. We initiated a pilot project 2 years ago. In this project, youths are transported to a local nonprofit shelter, rather than to a SODA bed, after appropriate checks and parental contact are made. The Hollywood Division states that the pilot project has saved hundreds of hours of police time and that the vast majority of youths referred have not come in contact with law enforcement officials again. Short-Term Crisis Shelter
Through the Coordinating Council we help coordinate the services provided by Angels Flight, Options House, Stepping Stone, 1736 Crisis Center, NCIR Inc., Centrum, Covenant House, Aviva Respite Shelter, and the Yoiath Network. In all, 88 crisis shelter beds are available, along with the 36 SODA beds of the County Probation Department. Ths~ugh the Coordinating Council process, agencies are encouraged to refer youths to the most appropriate shelter based upon individual profdes developed under agreed-upon criteria. The medical and psychotherapeutic services of the High Risk Youth Program are made available to all youths in crisis shelters, where they receive food, showers, an? crisi: atervention counseling. As much as possible,. youths W!XIhave completed the maximum length of stay in a c ,-isissheiter and who have not been reunited with their familiesor given alternative placementare referred to the longterm stabilizationprograms. When programs are full because of lack of space, youths may be hzrrscd ic another crisis shelter until space becomes available. Small subcontracts exist with many of the nonprofit shelters to promote this collaborative referral process.
558
YATES ET AL.
Comprehensive Medical and Psychosocial Care The High Risk Youth Program demonstrated that the physician-patient relationship provides aneffec t-ive method for initial intervention with street youth. When physicians demonstrate a genuine concern for the youths’ well-being, these young people will reveal personal problems that they would not readily share with others. A medical complaint (e.g., sexually traizsmitted disease) can open the door to the treatment of a whole range of health and psychosocial concerns. In the course of the medical examination, the physician conducts a psychosocial interview to determine further areas of need, such as food, shelter, job, mental health counseling, and drug abuse counseling. If the young person wants assistance in any of these arer.s, the physician introduces him or her to another member of the interdisciplinary team (social worker, counselor, health educator), who will take over from there. To maximize the willingness of street youth to come forward for treatment, we operate our clinics at the Los Angeles Free Clinic, that has long been known as a “safe place” among the street population. A variety of professional resources is available at this one site when clients come in for help. The Division of Adolescent Medicine has an interdisciplinary staff, including physicians, residents, psychotherapists, social workers, and others, who merge with the professional and volunteer staff of the LOS Angeles Free Clinic. Clinics are offered Tuesdays 2nd Thursdays from 3 to 7 p.m.; a mobile team composed of a nurse practitioner and two social workers provides medical screenings and referrals on Mondays and Wednesdays at drop-in centers and shelters.
Long-Term Shelter and Case Management The Los Angeles Youth Network (LAYN) receives a substantial subcontract to operate a 20-bed shelter and a comprehensive case management center. They provide emergency services (food, shelter), crisis intervention, long-term stabilization, and follow-up. The shelter operates as a transitional program; residents work tith counselors at the case management center durirpg the daytime. The focus of this intervention is king-term stabilization through family reunification alternate placement, or independent living Jf d youth abides by shelter rules and puts a reasonable amount of effort in% following his or her case plan, the bed may be held for up to 60 days. Dinner, breakfast, and shower facilities are
JOURNAL OF ADOLESCENT HEALTH Vol. 12, No. 7
provided to the youths in the shelter. Transportation to medical exams and counseling appointments is al ilc3available. To inzrrease ~qportunities for street youth to become stable an33 remain off the street, the Gay and Lesbian Community &r&es Cen?er has developed an expanded transition program for youths who have found work. Citrus Youth House (12 beds) and Citrus Adult House (12 beds) keep youths for an additional 60 days and provide stability as they become more adjusted to independent living. In addition, 14 other long-tern1 independent living beds are avaiilable. The Los Angeles County Department of Children’s Services Runaway Adolescent Pilot Project (RAPP) is another important component of the system’s long-term stabilization services. Established in 1986, the project emphasizes strong linkages with the existing runaway youth service system, extending the services of the department’s child welfare programs to adolescent runaways with a history of abuse and neglect. Runaway youths and their families are provided, on a voluntary basis, family reunification assistance, foster care placement, and independent living services using a vertical case management model. Since 1986, RAPP haa served nearly 800 youths, with more than one-third of them returning to the homes of their parents or relah,i,;y3. PPAPP complements the existing system of caI‘e by offering long-term group home/foster care services to youths who are unable to return home immediately and are uct ready to live independently.
System Data
CoZZection
Standardized and system-wide data collection is another important aspect of the development of this system of services. The Division of Adolescent Medc-ine currently collects demographic, personal histq,. and diagnostic data on all young people who receiti. health screening or treatment. Since October 1986 we have also been collecting monthly demographic data on teens served by 13 member agencies of the Coordinating Council. This expanding database has provided the first in-depth look at the characteristics of young people seen by runaway agencies in Los Angeles County. It has direct implications not only for practice but also for policy making and for a better understanding of the problems of runaway and homeless youth. Data collected from October 1986 through September 1989 revealed that 1) shelter agencies turned away 8,357 young people, while sheItering8,593; 2)
BJovember 1991
the young people sheltered were 15 years old j)r younger, and some were as young as 9; 3) 44% of the young people sheltered had a history of abust wrneglect (as this figure was based on intake reports, it is probably an understatement); 4) 55% of the youth shelteredwere ethnic minorities;5) only 20% of the yo”ng people seen by shelter agencies were good candidates for immediate family reunification; 6) 35% of those sheltered were homeless, with no home or out-of-home placement to which they might return; 7) 25% were chronic runaways who were very unlikelyto be returned home or to be placed; 8) 47% of the young people seen by outreach agencies were homeless, with 76% from outside Los Angeles County and with no residence other than the streets; and 9) 70% of the youths sheltered by nonprofit agencies and 35% of Che youths seen by drop-in centers were either reunified with families or helped to another suitable alternative (foster care, group home, or independent living). This profile of the youth served, along with data showing the succ css d 5~ inditidual components of the system of care, has never before been available and has acted as a catalyst for developing additional serilces for this homeless population. Duririg the past 3 years the availability of emergency shelter beds for homeless youth in Los Angel;,, Cormty increased from 82 TV124, the number of transitional (long-term) living be& increased frcm 0 to 88, and the number of drop-in >enters inkreased from 4 to 9 (Table 1). The most visible impact of the increase in resources was a dramatic redWti6n of the number cri: youths being turned away irom shelter. During the first year of the system data collection, 3,494 youth requesting shelter were turned away but during 1989 this was reduced to 1,829, a 48% decrease! In addition, although the number of individual youths coming in contact with service providers continued to increase, the number of yoc:hs visible on the streets has dropped dramatically. This is especia.ily true in the Hollywood area, where both agency outreach workers and police officers report finding fewer and fewer minors on the streets. This phenomenon is partially expiained by the ,?~t that 88 emergen.7 shelter and transitional livirig beds, as well as 8 drop-in centers, are currently available in Hollywood. The growth of the seririce system in Los Angeles over the past 3 years d~s not mean that the problems of runaway/homeless youth in Los Angeles are completely resolved. More than 1,800 youths were 4F% of
X&l:.: .__~_ I. System of Care, Los Angeles Country, 11/15/89 MO.
Agency
beds
Emergency shelters (124 beds) 6 NClR Inc. 8 Angels Flight 6 options House 6 Stepping Stone 6 1736 Crisis Center 6 Aviva Respite 20 LA Youth Network 10 Centrum 36 SODA (Probation) 20 Covenant House Transitional living shelters (88 beds) 4 Middle House 12 Citrus Youth House :2 Citrus Adult House 10 Teen Canteen 50 RAPPIDCS Drop-in centers Covenant House Children of the Night Gay and Lesbian Center Angels Flight Hollywood Teen Canteen The Way In Angels FIight Venice Hope Chapel Los Angeles Youth Network
Length of stay
Age range served (yr)
14 days 14 days IiS day5 14 days 14 days 30 days 60 dsys 7 da,j= 3 day,, 6-10 dzF ‘,
12-17 12-17 12-1.7 12-17 12-17 12-17 12-17 12-17 12-17 18-20
9 months 2 months 2 months 12 months 6 months
12-17
12-17 M-23 18-23 12-17 12-20 12--?7 12-23 12-17 B2-23 12-21 12-17 12-23 12-23
NCIR, National Center for Auman Rights; LA, Los Angeles; SODA, Status Offender Detention Alternative; RAPP ‘KS, Runaway Adolescent Pilot Project
GARY L. YATIGS, M.A.,
B.C.C.,
A.VON SWOFPORD,
AND RICHARD
B.A.,
JULIA
PENN
Runaway and homeless young people generally do not seek help unless they are in a severe personal crisis. IFor the past 7 years, t e Division of Adolescent icine, Childrens Hospital of Los Angeles, has learned a good dea.1about bow to intervene effectively with these youths and divert them from high-risk behaviors such as prostitution and drug abuse. The program model we have developed has five major components: 1) networking and consolidation, 2) outreach, 3) short-term crisis sheiter, 4 comprehensive medical and psychosocial care, and 5) long-term shelter and case management. Our approach has been collaborative; we subcontract a substantial portion of the work to other youth agencies in the community in order to build and strengthen the network of existing services. In the process, we have moved steadily closer to developing a comprehensive system of care for homeless strecc youth throughout Los Angeles County. Where programs previously ope:id& in klative isolation, representatives from 40 private and public agencies now meet regularly at Childrens Hospital of Los Angeles to discuss ways to improve services. Systematized data collection has helped agencies understand how they can work together and has prompted additional funding for needed services. KEYWORDS:
Momelessyouth Runaway youth Community services Case management Outreach From tkc Division of Adolescent Medicine KXY., J,P., A.S., R.G.M.1, Childrens Hospital of Las Angeles, and the Departments of Pediatrics (G.L.Y., R.G.M.) and MedicLe (R.G.lt:J, University of Soutkpm California, Sckool of Medicine, Los Angek ,i, California. Address reprint requests to: Gary L. Yat’es, ML., M.F.C.C., Division of Adolescent Medicine, Childrens Hospital of Los Angeles, P.0. Box 54700, Los Angeles, CA 90054. Manuscript awpted November 20, 1990.
IBGE,
Ph.D.,
Hospital of Los Angeles has a Wyear tradition of community service. Founded by a grou of charitable women, our first hospital consisted of 4 beds in a converted Zstory frame house. From those modest beginnings, the hospital has grown to a 33P-bed facility situated on a 9-acre campus. Whereas the hospital has changed and grown dramatically over the course of its history, its commitrAw?nt to community service has continued to underpin its mission. As in the past, the hospital is a vital resource to the community it serves by providing necessary medical care to children from financially needy families. Our sommitment to community service has intensified as the neighborhood around the hospital has changed. The Hollywood/Wilshire area of Los Angeles has a population of 415,913, with 41% having incomes below 200% of the poverty level. The area has become an entry point for immigrants from around the world; more than 30 languages are spoken by students at Hollywood High School. Disturbingly, our area has also become a focal point for troubled young people, who gravitate to Hollywood from all over the country. Drug use and prostitution are endemic to the areas where they congregate along Hollywood and Santa Monica Boulevards and on the Sunset Strip. Many of these young peop1.e have r;m from. homes where they were victims of abuse or neglect. They are hurt, alienated, and distrustful of traditional health care agencies. They are clearly medically at risk, but their neecis extend beyond mere hea. th care. Without proper intervention, they will become the next generation of adult homeless. Since July 1982 the Division of Adolescent Medicine, Childrens Hospital of Los Angeles, has Childrens
G Society Par Adole: cent Medicine, 1991 Published by Elsevier Science Publishing Cc,., Inc., 655 Avenue of the Americas, New York, NY ItYIlO
555 1054-139x/91/$3.50
556
YATES EI- AL.
worked to improve services for street youth in the .Hollywood area through our High Risk Youth Program. This effort was begun with funding from the Rob& Wood Johnson Foundation as part of a national program to pilot consolidated health services for high-risk young people. Our success in reaching chronic street kids, previously thought unreachable, has attracted both time-limited government and private funds. As a result, we have been able to expand our services significantly. Our approach has been collaborative, as we subcontract a substantial portion of the work to &her agencies serving youth in the community. This both builds and strengthens the network of existing services.
The Problem California has become a popular haven for homeless street youth. It has a large population (alea.ost 10% of the entire nation), warm weather, numerous beaches, and a reputation for being a “cool place.” Nevertheless, researchers, service providers, and public agencies alike find it hard even to estimate the number of these youths in the state. A report published in 1985 suggested that the annual number of runaway or homeless youths in California ranged from 12,700 to 128,ooOand concluded that there was no reliable basis for arriving at an accurate number (1). In 1981, the United Way Planning Council sponsorea a study of Los hgeles County. The resulting report e&mated that there were 10,000 runaways in the county at any given moment, with the number swelling to 20,000 during the summer m0nth.s of July and August (2). 3’he report stressed that the figures were estimates and advised caution in interpreting them because fJf the impossibility of accurately esthidlg the t@al runaway population. In 1985, researchersat the Universityof California at Los A.n@ts School of SocialWelfare surveyed 48 members of the runaway and homeless youth services community in Los Angeles who had been identified as experts in the field (3). The researchers found that the exact number of youths needing services could not be determined. They also found that in recent years the runaway population in Los Angeles County has become younger, more ethnically varied, and more emotionally disturbed; and that these youth are coming from highIy dysfunctional families. The multiple health and medical needs of homeless street youth are clear from an analysisof a single
JOURNAL OF ADOLESCENT HEALTH Vol. 12, No. 7
year’s data (1985) from the medical clinic operated for this population by the Division of Adolescent Medicine, Childrens Hospital of Los Angeles. Of the homeless youths seen by the clinic, 85% were diagnosed as depressed, 9% were diagnosed as actively suicidal, 20% were diagnosed as having previously attempted suicide, and 18% were suffering from other severe mental health problems, e.g., behavior, personality, or thought disorders. Medical diagnoses such as cardiac arrhythmia, hepatitis, pneumonia, renal failure, and generalized adenopathy occurred significantly more often among runaway and homeless youths than among those youths who were living at home (4). These increased health problems were associated with higher rates of ‘high-risk behaviors. More than one-half (52%) of thtcse street youths were diagnosed as abusing drugs ($ith 35% engaged in intravenous drug use), and 26S’admitted to involvement in prostitution. Because this information was acquired from an initial interview with a physician, it is reasonable to assume that these reports are actually underestimates of high-risk behaviors (4).
System Design and Operation Our development of a system of care for runaway/ homeless youth builds on the success of our High Risk Youth Program. Over the paot 7 years, we have learned a good deal about how to intervene effectively with street youths and divert them from highrisk behaviors such as prostitution and drug abuse. The program model we have developed has five major components: 1) “networking and consolidation, 2) outreach, 3) short-term crisis shelter, 4) comprehensive medical and psychosocial care, and 5) longterm shelter and case management.
Nehworking and Consolidation All too often, socialservice agencies focus their energies on their own activitiesand fail to communicate effectivelywith one another. The gap between public and private agenciescan be particularlywide. For example, there is frequentlya lackof communication between youth agencies and local law enforcement, fueled by mutual distrust. When this happens, young people in need can “fall through the cracks” and fail to receive the help they need. A grant from the CaliforniaState Officeof Criminal Justice Planningunder the CaliforniaHomeless
November1991
Youth Act of 1985 allowed us to organize more than 40 agert&s operating in Los Angeles County into a Coordinating Council for Homeless Youth Services. The CounciI aeets at Childmns Hospital of Los Angeles on B quarterly basis and provides input and advice concerning program design, function, and direction. It .also serves to identify gaps and overlaps in services for runaway and homeless youth in the Hollywood/Wilshire area.
Runaway and homeless young people will generally not seek help for themselves unless they are in the middle of a severe personal crisis. In order to contact them before crises arise, our collaborating agencies use a var:iety of outreach strategies. Street outreach workers go to areas where street kids congregate and give out cards with the phone numbers and addresses of our clinic and other local programs. Agencies operate hotlines so they are accessible to young people who are unable to visit them. Agencies also operate drop-in shelters where clothing, food, and bus tokens are distributed.They also offer criss counseling, showers, and storage space. To increase the scope of efforts to contact homelesi youth, we have developed subcontracts with several existing outreach agencies in Los Angeles County. The purpose of these contacts is to provide tkese agencies (Angels Flight; Project Warn-Gay and Lesbian Community Services Center; Hollywood YMCA; Los Angeles (LA) Youth Network; Teen Canteen) with additional resources so that more young people can be contacted and referred to available services. TQ intensify collaboration among butreach agencies, we have convened a monthly meeting of outreach staff at Childrens Hospital of Los Angeles. Also, to systematize the prevention message given to street youth, we have provided a standardized training to all outreach agencies. Laa:r enforcement in Los Angeles CoTtinty plays a critical role in the system of care bv locating youths and trarsporting them to emergericy shelter. Under current statures, law enforcement can hold youths in detention while attempting to contact parents or guardians. Out-of-county youths may be held for 72 hours, whereas Iocal residents may be held up to 24 hours. Standard operating procedure for law enforcement in processing runaway and homeless youths is to transport youths to the local station, run “wants and warrants” checks on them, try to contact their
LOSANGELESSY§TFMOF CARE
557
parents, and then transport the youths to an open Probation Department Status Offender Detention Alternative(SODA) bed in a temporary foster home setting. Unfortunately, the SODA foster families can provide only limited services. They are often not trained to deal effectively with the problems of runaway and homeless adolescents and provide no structured daytime counseling or case management services. As a result, 45% of the youths served leave the program within a iew days. Not only do many youths leave the program, the paperwork associated with getting a youth into a SODA bed can take law enforcement officers several hours. In an attempt to reduce this processing time yet still help runaway youth, we have worked closely with the Hollywood Division of the Los Angeles Police Department. We initiated a pilot project 2 years ago. In this project, youths are transported to a local nonprofit shelter, rather than to a SODA bed, after appropriate checks and parental contact are made. The Hollywood Division states that the pilot project has saved hundreds of hours of police time and that the vast majority of youths referred have not come in contact with law enforcement officials again. Short-Term Crisis Shelter
Through the Coordinating Council we help coordinate the services provided by Angels Flight, Options House, Stepping Stone, 1736 Crisis Center, NCIR Inc., Centrum, Covenant House, Aviva Respite Shelter, and the Yoiath Network. In all, 88 crisis shelter beds are available, along with the 36 SODA beds of the County Probation Department. Ths~ugh the Coordinating Council process, agencies are encouraged to refer youths to the most appropriate shelter based upon individual profdes developed under agreed-upon criteria. The medical and psychotherapeutic services of the High Risk Youth Program are made available to all youths in crisis shelters, where they receive food, showers, an? crisi: atervention counseling. As much as possible,. youths W!XIhave completed the maximum length of stay in a c ,-isissheiter and who have not been reunited with their familiesor given alternative placementare referred to the longterm stabilizationprograms. When programs are full because of lack of space, youths may be hzrrscd ic another crisis shelter until space becomes available. Small subcontracts exist with many of the nonprofit shelters to promote this collaborative referral process.
558
YATES ET AL.
Comprehensive Medical and Psychosocial Care The High Risk Youth Program demonstrated that the physician-patient relationship provides aneffec t-ive method for initial intervention with street youth. When physicians demonstrate a genuine concern for the youths’ well-being, these young people will reveal personal problems that they would not readily share with others. A medical complaint (e.g., sexually traizsmitted disease) can open the door to the treatment of a whole range of health and psychosocial concerns. In the course of the medical examination, the physician conducts a psychosocial interview to determine further areas of need, such as food, shelter, job, mental health counseling, and drug abuse counseling. If the young person wants assistance in any of these arer.s, the physician introduces him or her to another member of the interdisciplinary team (social worker, counselor, health educator), who will take over from there. To maximize the willingness of street youth to come forward for treatment, we operate our clinics at the Los Angeles Free Clinic, that has long been known as a “safe place” among the street population. A variety of professional resources is available at this one site when clients come in for help. The Division of Adolescent Medicine has an interdisciplinary staff, including physicians, residents, psychotherapists, social workers, and others, who merge with the professional and volunteer staff of the LOS Angeles Free Clinic. Clinics are offered Tuesdays 2nd Thursdays from 3 to 7 p.m.; a mobile team composed of a nurse practitioner and two social workers provides medical screenings and referrals on Mondays and Wednesdays at drop-in centers and shelters.
Long-Term Shelter and Case Management The Los Angeles Youth Network (LAYN) receives a substantial subcontract to operate a 20-bed shelter and a comprehensive case management center. They provide emergency services (food, shelter), crisis intervention, long-term stabilization, and follow-up. The shelter operates as a transitional program; residents work tith counselors at the case management center durirpg the daytime. The focus of this intervention is king-term stabilization through family reunification alternate placement, or independent living Jf d youth abides by shelter rules and puts a reasonable amount of effort in% following his or her case plan, the bed may be held for up to 60 days. Dinner, breakfast, and shower facilities are
JOURNAL OF ADOLESCENT HEALTH Vol. 12, No. 7
provided to the youths in the shelter. Transportation to medical exams and counseling appointments is al ilc3available. To inzrrease ~qportunities for street youth to become stable an33 remain off the street, the Gay and Lesbian Community &r&es Cen?er has developed an expanded transition program for youths who have found work. Citrus Youth House (12 beds) and Citrus Adult House (12 beds) keep youths for an additional 60 days and provide stability as they become more adjusted to independent living. In addition, 14 other long-tern1 independent living beds are avaiilable. The Los Angeles County Department of Children’s Services Runaway Adolescent Pilot Project (RAPP) is another important component of the system’s long-term stabilization services. Established in 1986, the project emphasizes strong linkages with the existing runaway youth service system, extending the services of the department’s child welfare programs to adolescent runaways with a history of abuse and neglect. Runaway youths and their families are provided, on a voluntary basis, family reunification assistance, foster care placement, and independent living services using a vertical case management model. Since 1986, RAPP haa served nearly 800 youths, with more than one-third of them returning to the homes of their parents or relah,i,;y3. PPAPP complements the existing system of caI‘e by offering long-term group home/foster care services to youths who are unable to return home immediately and are uct ready to live independently.
System Data
CoZZection
Standardized and system-wide data collection is another important aspect of the development of this system of services. The Division of Adolescent Medc-ine currently collects demographic, personal histq,. and diagnostic data on all young people who receiti. health screening or treatment. Since October 1986 we have also been collecting monthly demographic data on teens served by 13 member agencies of the Coordinating Council. This expanding database has provided the first in-depth look at the characteristics of young people seen by runaway agencies in Los Angeles County. It has direct implications not only for practice but also for policy making and for a better understanding of the problems of runaway and homeless youth. Data collected from October 1986 through September 1989 revealed that 1) shelter agencies turned away 8,357 young people, while sheItering8,593; 2)
BJovember 1991
the young people sheltered were 15 years old j)r younger, and some were as young as 9; 3) 44% of the young people sheltered had a history of abust wrneglect (as this figure was based on intake reports, it is probably an understatement); 4) 55% of the youth shelteredwere ethnic minorities;5) only 20% of the yo”ng people seen by shelter agencies were good candidates for immediate family reunification; 6) 35% of those sheltered were homeless, with no home or out-of-home placement to which they might return; 7) 25% were chronic runaways who were very unlikelyto be returned home or to be placed; 8) 47% of the young people seen by outreach agencies were homeless, with 76% from outside Los Angeles County and with no residence other than the streets; and 9) 70% of the youths sheltered by nonprofit agencies and 35% of Che youths seen by drop-in centers were either reunified with families or helped to another suitable alternative (foster care, group home, or independent living). This profile of the youth served, along with data showing the succ css d 5~ inditidual components of the system of care, has never before been available and has acted as a catalyst for developing additional serilces for this homeless population. Duririg the past 3 years the availability of emergency shelter beds for homeless youth in Los Angel;,, Cormty increased from 82 TV124, the number of transitional (long-term) living be& increased frcm 0 to 88, and the number of drop-in >enters inkreased from 4 to 9 (Table 1). The most visible impact of the increase in resources was a dramatic redWti6n of the number cri: youths being turned away irom shelter. During the first year of the system data collection, 3,494 youth requesting shelter were turned away but during 1989 this was reduced to 1,829, a 48% decrease! In addition, although the number of individual youths coming in contact with service providers continued to increase, the number of yoc:hs visible on the streets has dropped dramatically. This is especia.ily true in the Hollywood area, where both agency outreach workers and police officers report finding fewer and fewer minors on the streets. This phenomenon is partially expiained by the ,?~t that 88 emergen.7 shelter and transitional livirig beds, as well as 8 drop-in centers, are currently available in Hollywood. The growth of the seririce system in Los Angeles over the past 3 years d~s not mean that the problems of runaway/homeless youth in Los Angeles are completely resolved. More than 1,800 youths were 4F% of
X&l:.: .__~_ I. System of Care, Los Angeles Country, 11/15/89 MO.
Agency
beds
Emergency shelters (124 beds) 6 NClR Inc. 8 Angels Flight 6 options House 6 Stepping Stone 6 1736 Crisis Center 6 Aviva Respite 20 LA Youth Network 10 Centrum 36 SODA (Probation) 20 Covenant House Transitional living shelters (88 beds) 4 Middle House 12 Citrus Youth House :2 Citrus Adult House 10 Teen Canteen 50 RAPPIDCS Drop-in centers Covenant House Children of the Night Gay and Lesbian Center Angels Flight Hollywood Teen Canteen The Way In Angels FIight Venice Hope Chapel Los Angeles Youth Network
Length of stay
Age range served (yr)
14 days 14 days IiS day5 14 days 14 days 30 days 60 dsys 7 da,j= 3 day,, 6-10 dzF ‘,
12-17 12-17 12-1.7 12-17 12-17 12-17 12-17 12-17 12-17 18-20
9 months 2 months 2 months 12 months 6 months
12-17
12-17 M-23 18-23 12-17 12-20 12--?7 12-23 12-17 B2-23 12-21 12-17 12-23 12-23
NCIR, National Center for Auman Rights; LA, Los Angeles; SODA, Status Offender Detention Alternative; RAPP ‘KS, Runaway Adolescent Pilot Project
