Social Determinants of Health: Building Relationships with Youth Experiencing Homelessness

Coordinating Care around the Social Determinants of Health is a blog series featuring clinician stories that illustrate the impact of safety-net health centers coordinating adolescent care through a social determinants lens. Read more posts in the series here.


Neighborcare Health’s Homeless Youth Clinic (HYC) strives to empower Seattle-area youth who experience homelessness to improve their overall wellbeing. While many young people in the United States struggle with the adverse effects of toxic stress and trauma, youth who experience homelessness are particularly vulnerable. They may lack the social and personal resources to process issues that come up with normal adolescent development, and that’s to say nothing of the stressors associated with unstable and unsafe housing. HYC focuses on client relationship building and individual outreach to empower these young people to take their health into their own hands.

“When we succeed at making a personal connection with adolescents, they are much more likely to take advantage of the services we offer, to get the help they need.”
-Charlotte Sanders, former clinician at HYC and current field lead of the Northwest Leaders in Behavioral Health Program at the University of Washington

Part of making that personal connection is the ability to relate to adolescents through shared experiences—having been in the spaces and situations they are. HYC employs peer coordinators to achieve that goal. These coordinators work with HYC staff to organize community outreach events that connect them with the youth. Being part of the community helps HYC to have the reach, trust, and resources to effectively treat their patients. The center also provides alternative services, including yoga, meditation, homeopathic methods, and acupuncture. Their goal is to get youth to “identify the clinic not just as ‘where I go when I’m sick,’ but also where I go to be well,” Sanders says. Community partners can refer patients to the services at the clinic, but they believe “young people are our best outreach.” The majority of referrals come from current or former patients.

Asking the Right Questions

Mindful of the many social and economic conditions that affect their clients’ health, HYC uses an intake form that probes for biological, sociological, and psychological issues. Those results give doctors a more complete picture of their medical history. Sanders notes that “adolescents may not fully grasp the enormity of their position, or may be wary of disclosing it.” For that reason, HYC asks questions about their current situation rather than labeling them. “Where did you sleep last night?” instead of “Are you homeless?” and “How did that interaction make you feel?” versus “Have you been assaulted?

All staff receive specific training on how best to advocate and provide for adolescents who are experiencing the effects of homelessness. They grasp the importance of what Sanders calls “TLC visits” where a young person schedules an appointment, but not for anything in particular. These visits are often because the adolescent is seeking reassurance or connection. It all goes back to the relationship building: Sanders insists that staff reach out to those patients in need so they feel welcomed, accepted, and empowered to come back to receive the care they deserve.

Meet Adam

Adam* was a new patient at Neighborcare Health’s 45th Street Youth Clinic. The clinic helped Adam get a reservation at a shelter. However, during in his first few visits he displayed signs of aggressive anxiety—even getting so upset he would shout and berate clinic staff. But rather than abandon Adam, one clinic staffer worked to build a relationship with him, talking with him rather than confronting him, and getting a better handle on where he was emotionally. During these conversations, Adam mentioned a history of severe childhood abuse.

At their daily debriefing that day at the clinic, staffers discussed the incident, and Adam’s recent behavior. They realized that he never started to get upset until it was time for him to leave the clinic and return to the shelter. Hypothesizing that transitions were likely triggers for this child, the staff agreed to never leave him alone while at the shelter, in the waiting room, or walking to an examine room. In this way, they were able to build a relationship with Adam. Clinic staff were also able to connect Adam with a peer who accompanied him to and from the shelter, so that he could be more secure in his placement and build a sense of community. As Adam became more comfortable, he agreed to work with the counseling staff, and kept coming back for behavioral health and medical visits. Through his time at the 45th Street Youth Clinic, staff saw Adam grow from an anxious, angry, and distressed child to an engaged and resilient young man.

Ready to learn more about the social determinants of health?

Click this link to read an interview with Dr. Tamara Baer about her research on integrating a social determinants lens into community clinics when working with adolescents.

Read More

*Names have been changed to protect confidentiality.

Acknowledgements

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under cooperative agreement number U30CS09738-08-00, award title “Technical Assistance to Community and Migrant Health Centers and Homeless” for $450,000. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.

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