NURSING ISSUES AND HOMELESS YOUTH
PRESENTED BY MICHELLE ALLEN AND LORI UMENHOFER

I. Research and Awareness
A. Homeless youth face the same issues faced by children in the general population, but their issues are exacerbated by the circumstances inherent to their homeless status.
B. As touched upon in the skit, some of the health care issues especially prevalent in the homeless youth population are psychosocial issues, nutrition issues, communicable diseases, dermatological disorders, respiratory disorders, dental health issues, sexual health issues, substance abuse issues, and issues related to medication adherence.

II. Psychosocial Issues
A. Multiple studies have identified the adverse effects of homelessness on children’s psychosocial health.
1. Kern Medical Center Study – In comparison to other poor children who have never been homeless, there is increased risk for depression, anxiety, behavioral problems, and academic problems in homeless children.
B. Women who are homeless during pregnancy usually do not have access to prenatal care, are often undernourished, and are often substance abusers – all of which leads to low birth weight babies with neurobehavioral problems predisposing them to lower academic achievement and behavioral issues at higher rates than children who are not homeless.
C. Studies such as those carried out by the Health Care for the Homeless Clinician’s Network show that, for children who are homeless with their families, under stimulation by mothers preoccupied with survival concerns for themselves and their homeless children frequently results in developmental delays for children under five years of age. 1. Personal Anecdote – Experience of gunfire outside home 2 weeks ago kept me awake most of the night, afraid for my safety and that of my children. I was INSIDE the four walls of a home/sheltered. I can not imagine facing this on a daily basis – not feeling safe, focusing on staying survival above all else. I can understand preoccupation with safety and survival and how that could cause a mother to be unable to provide for her children in other ways and be unresponsive to their other needs. When you are simply tying to survive and be safe, all else falls to the wayside.
D. Homeless children attend school erratically or not at all due to frequent moves and obstacles related to such things as registering without an address, without health care records, or sometimes without a legal guardian. This leads to obvious developmental and psychosocial delays.
E. When children become sick, they often receive inadequate treatment, either because they can not afford it, or because it is low on their or their families’ priority list where safety and survival are at the forefront. Things such as untreated ear infections can lead to hearing loss that can affect speech and language development and impede the ability to learn.
F. The loss of stability and safety, fractured families, overcrowded living conditions of shelters, exposure to disease, witnessing violence, substance abuse, and mental illness are all conditions that exacerbate emotional problems in homeless youth. Again, the treatment of these problems often receives low priority from parents who are trying to ensure the safety and survival of themselves and their homeless family.
II. Nutrition Issues
A. As mentioned in the skit, limited or non-existent financial resources can lead to children not being fed at all if they are not able to obtain shelter meals.
B. When limited finances are available, inexpensive fast food restaurants or convenience stores are the most common source for inexpensive food, which carries little nutritional value. As a result, many homeless children suffer from nutritional deficits including malnutrition, obesity, and anemia.
III. Communicable Diseases
A. Another concern for homeless youth. As a result of staying in crowded shelters where many inhabitants are sick, homeless children are at a higher risk for contracting infectious diseases.
B. Homeless children often experience immunization delays, or are not immunized at all, resulting in an increased vulnerability to communicable diseases such as tuberculosis, chicken pox, meningitis, and influenza.
IV. Dermatological Disorders
A. Another issue. The delicate skin of youth without shelter and regular hygiene is highly susceptible to frostbite, infection, and parasites.
B. Disorders related to staying in crowded shelters where others carry communicable diseases include scabies, chicken pox, and body and head lice.
V. Respiratory Disorders
A. As mentioned in the skit, respiratory issues are common in homeless youth.
B. Common triggers for asthma and other disorders include dust mites, cockroaches, rodents, and indoor molds, and are prevalent in homeless shelters.

V. Dental Health
A. Oral health is often neglected by homeless youth.
B. Lack of finances prevent youth from obtaining regular dental screenings. Lack of access to facilities and supplies prevent youth from practicing regular oral hygiene. Dental problems can lead to other systemic health problems.

VI. Sexual Health
A. As touched upon in the skit, sexual health issues such as pregnancy and sexually transmitted disease are prevalent among the homeless youth population.
B. Many homeless youth are victims of rape resulting from dysfunctional familial contact or from violent contact with strangers in the shelter setting.
C. Many homeless youths barter sex in exchange for a place to sleep, or for a meal or clothing, resulting in risks for STD’s and pregnancy.

VII. Substance Abuse
A. Also mentioned in the skit, substance abuse is prevalent among homeless youth, but homeless teens in particular.
B. The mental and emotional problems faced by homeless youth including the stress related to being homeless and witnessing violence on the streets leads many to substance abuse. Studies by the Health Resource and Services Administration show that the highest rates of substance abuse amongst youth in general are seen in street youth, followed by shelter youth and runaways, and finally by housed youth.
VII. Medication Use and Adherence
A. When homeless youth do become ill and actually seek treatment, there are additional problems to consider.
B. Without a home, there is no place to recuperate from illness or injury. As mentioned in the skit, without finances, there is often no capability for acquiring medication necessary to treat an illness, and if medication is acquired, there is often lack of the food or drink required to administer it properly. When frequent relocation is a fact of life, there is no continuity of follow-up care. All of these issues contribute to the fact that, when homeless youth do experience illness, problems tend to get far worse before they get better.

All of these facts raise importance issues for nursing and the population of homeless youth…