In the range of issues faced by community and public agencies that provide behavioral healthcare, one problem stands out as especially intractable: the care of homeless teens whose mental health problems often are exacerbated by drug or alcohol addiction and, sometimes, mental retardation.
These homeless adolescents with co-occurring disorders are hard to reach, treat, and follow up. Their lives usually are complicated by a lack of family or an irreparable break with family. And life on the streets means routine encounters with drug dealing and prostitution, the threat of STDs, and violence.
At FamilyLinks, Inc., a multipronged social service agency in Pittsburgh, we run the only homeless shelter in our area that exclusively serves young people—those in the 18- to 21-years-old range—and we've found that about 40% of the approximately 150 to 200 youths we shelter over the course of a year will have co-occurring disorders.
We have found over the years that patience and a very carefully measured amount of tolerance are our greatest assets in caring for youth with co-occurring disorders. Working with homeless youth in general is sometimes like trying to push a length of string across a table while keeping it in line: It's frustrating to say the least. Youths often are reluctant to come into the shelter and sometimes are reluctant to stay. With youth with co-occurring disorders, the added problem is getting them to accept that they have mental illnesses and substance abuse habits that need to be treated. Denial abounds.
Below are eight principles we have established for helping homeless teens with co-occurring disorders—eight factors that we think are important to our success.
Be there and stay there. One factor that sets us apart from many shelters is that we are always open. Youths can come to us at 4 a.m. or 4 p.m. on any day—including Christmas Day and New Year's. Since we are not a lockdown facility, youths are free to come and go, and a few stay only a night or two. While a 30-day stay is the official target, the average stay is between 30 and 45 days, and a few stays extend to 90 days or more.
Be patient and learn. Youths don't announce their problems, and it takes time to know for sure all of the emotional weights, doubts, or scars of abuse that might be affecting a teenager. Almost all teens readily hide problems from adults, and troubled ones can be particularly adept at it. While mental retardation and drug addiction may be relatively easier to spot, evidence of depression or alcohol abuse may not. A young man who decides he wants to go on a drinking binge Friday night might arrange to stay with a friend and not come back to the shelter that weekend. So sometimes we need to get information through word of mouth, from our contacts on the street, or from other youths, and it often takes time for that to happen.
Figure. Total number of service linkages for two defined periods. The average number of linkages per client is four. A “linkage” represents one referral contact a client uses to meet a particular need. "Subsistence needs" are food, clothing, and shelter/housing.
Have empathetic medical professionals on staff. Homeless teenagers do not get the medical attention they need. They have no resources, usually no insurance, and no one to guide them through the healthcare system. As a result, healthcare needs are deferred, and a medical problem may fester until it requires a visit to an emergency room. We have a nurse practitioner at our facility three days a week who sees every young man or woman we work with. Aside from the medical attention she provides, our nurse practitioner is well skilled at listening and often can get more information out of youths than a doctor or other staffers, particularly when it comes to issues of emotional health, abuse in the family, or a well-disguised addiction. It is important to have a medical professional who works empathetically with youths.
Develop a network of competent professionals in your own agency and outside your agency. Aside from the services provided by other parts of FamilyLinks, we have a core group of other social service agencies that we work with. We refer youths to them for training, counseling, or medical services, while they refer homeless youths they encounter to us for the shelter and services we provide. One major partner has a daytime drop-in center for youths and provides stipends to those working on becoming more job ready, along with jobs counseling and specific jobs training. We work with agencies that can provide transitional housing or more permanent apartments. Pittsburgh's Mercy Hospital, which is just up the street from our shelter on the edge of Pittsburgh's downtown, has a top-notch emergency room that backs us up. We also work closely with the Western Psychiatric Institute & Clinic (WPIC), part of the region's major health center, which is only a mile away. We're also very much involved in the national YMCA Safe Place program. The figure quantitatively displays our success with linkages to needed services for youths.
Use every funding source you can find. Our primary funding is from Allegheny County, but we also use Community Development Block Grants, McKinney Act money for nursing services and case management, and a Federal Basic Center grant and street outreach funds, both of which come under the Runaway and Homeless Youth Act. We even get some money from the Federal Emergency Management Agency for meals.