Social Determinants of Adolescent Health: Boston’s Most Vulnerable Populations Gain Easy Access to Vital Services

Coordinating Care around the Social Determinants of Health is a blog series featuring stories from clinicians that demonstrate the impact of safety-net health centers using a social determinants lens when providing coordination of care for adolescents. Read more posts in the series here.


By Andrea Shore, Director of Programs, School-Based Health Alliance

Think back to your most formative adolescent years. Imagine having to relive them in these dizzying times—only now, you have no stable family environment as a ballast. You’re not sure where you’ll sleep tonight, or where your next meal will come from. Adding to that anxiety, you feel a sense of severe isolation as a member of the LGBTQ community.

Scared, alone, vulnerable, where would you turn for even the most basic care?

The BorumFor many adolescents living these circumstances in Boston, Massachusetts, their answer is the Sidney Borum, Jr. Health Center—aka the Borum. Founded in 1993 specifically to serve homeless and at-risk youth, this state-licensed clinic offers non-judgmental health, mental health, and substance abuse services for young people ages 12–29 who may not feel comfortable going anywhere else.

A Specialized Approach for a Special Population

Many of the Borum’s patients have more acute needs than their peers. That’s due to a variety of destabilizing factors such as abuse, homelessness, and system involvement that lead to high rates of PTSD, depression, anxiety, and suicidal ideation.

Because a high percentage of homeless Boston youth identify as LGBTQ, the Borum specializes in providing care to this community. In fact, many patients travel here from the surrounding area because it’s hard to find qualified providers who accept LGBTQ patients or have knowledge of their issues.

I can tell you there’s far more to the Borum’s successful model than making young people feel welcome. The leadership and staff here have carefully honed a three-prong strategy that aligns very closely to the framework advanced by Baer et al:

1. Develop a comprehensive community resource referral system.

With the Borum, young patients have a simple, one-stop shop for their medical, behavioral health, and sexual health care, as well as case management.

The Borum’s greatest accomplishment may be lowering the barriers to care—an absolute must when serving populations that struggle with financial and housing instability. The clinic offers expanded walk-in hours for behavioral health care, same-day medical appointments, and on-call hours for when the center is closed. Most cases don’t even require referrals.

2. Improve triage for social determinants of health needs.

During each well visit, patients are handed iPads and asked to complete a variety of screening elements, including the PHQ9 for depression and the HEEADSS method, which screens for a wide variety of social determinants of health. There’s also screening for interpersonal violence.

Borum clinicians emphasize screening for unstable financial and housing situations, substance abuse, and self-harm—all frequent problems with LGBTQ youth. They take time to educate patients on consent and safe sexual activity.

The iPad survey results make it easy for providers to follow up with patients or refer them to other services where appropriate.

3. Expand the team to include a community resource connector.

That would be Jojo, an essential piece of the Borum’s puzzle. While the role has evolved over the clinic’s lifetime, it has always belonged to Jojo. She’s an amazing advocate who works closely with patients—along with team partners—to help meet their non-medical and behavioral health needs. These cover the spectrum from health insurance and housing to employment and documentation. She also works to increase their self-reliance.

Among the most challenging conditions Jojo helps patients deal with are homelessness, generational poverty, trauma, homophobia, transphobia, and racism—plus all the trappings that go with them.

An Ongoing Quest for Information

The Borum team has an excellent understanding of who they serve. Most importantly, they understand the need to continually uncover more information about their patients and the circumstances they face on a daily basis.

These discoveries point to services that ultimately give adolescents the best chance for a brighter future.

“For patients who are young and vulnerable, for patients at the crossroads of so much that can put them at risk…we do a really good job here having many different people in the clinic make relationships with them. I’ve certainly seen the benefits of that…because patients who otherwise wouldn’t have followed up with us get the care they need.” -Molly McHenry, NP, a provider at the Borum

Learn more about the social determinants of health
Click here to read more stories in this series
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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