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  • Writer's pictureJorge Petit

An Unseen Crisis: Youth Homelessness in the United States

As a follow-up to my last post and in recognition of November being National Homeless Youth Awareness Month, I want to call attention to another facet of the homelessness crisis that remains an unseen crisis that must be highlighted and addressed: youth homelessness.

In addition to this specific issue, but inexorably related, is the very concerning trend of children losing their Medicaid insurance because of the expiration of the COVID-19 public health emergency (PHE) continuous enrollment provision in March 2023. According to recent estimates, that number is close to 2 million children in the U.S. and potentially growing; this concerning trend impacts Blacks and Latinx children disproportionately. Without proper insurance coverage more youth will continue to fall through the cracks and become marginalized, disenfranchised, and sadly unseen.

The statistics regarding youth homelessness are staggering and mostly unknown to the vast majority: these children are unseen and unprotected, and we are not doing enough for them. Youth homelessness affects millions of young people in the United States, by some estimates, on any given night (2022), over 30,000 unaccompanied youth were counted as homeless—91% were between the ages of 18 to 24 and 9% were under the age of 18. Additionally it is estimated that 1 in 30 youth experience homelessness each year, which translates into over 4 million youth experiencing homelessness at some point in their lives. That is unconscionable and we should all be ashamed that there are children (and I think of my own 2 boys who are under the age of 18) alone and without a roof over the head.

Youth homelessness does not discriminate, affecting young people from all walks of life, regardless of race, ethnicity, gender identity, sexual orientation, or socioeconomic status. However, some groups of youth are more likely to experience homelessness than others, LGBTQ+ youth and Black youth are more likely to experience homelessness.

Youth homelessness, is a very complex issue that has a complex set of factors that contribute to it, see chart below:

Family Conflict can manifest in various forms, including physical abuse, emotional abuse, neglect, substance abuse, and parental incarceration. These experiences lead to a sense of instability, fear, and lack of support within the family, pushing young people to seek alternative living arrangements; especially prominent among LGBTQ+ identifying youth.

Poverty is a widespread cause of youth homelessness. When families struggle to make ends meet, may have to choose between basic necessities, such as food and utilities, or housing. This can lead to evictions, overcrowding, and a lack of stable housing conditions, which can increase the risk of homelessness for young people.

Abuse, of various kinds, is a major driver of youth homelessness. Youth who experience physical, emotional, or sexual abuse, within their homes may feel unsafe and not supported, leading them to flee in search of a safer environment. Escape from the abuse can lead to homelessness, as young individuals lack the resources and support systems necessary to secure alternative housing.

Lack of Affordable Housing and increasing housing costs, especially in cities, force families with limited financial means to face increasing difficulty finding and maintaining stable housing. This lack of affordable housing options can push families to overcrowd existing living spaces, increasing the risk of conflict and pushing youth into homelessness.

The intersectionality of factors create a complex web of challenges that contribute to youth homelessness; youth from marginalized communities, such as LGBTQ+ youth or youth of color, may experience a higher prevalence of family conflict, poverty, and discrimination, further increasing their risk.

As I wrote about in my prior blog, homelessness has a profound and lasting negative impact on the physical, social and emotional wellbeing of individuals, particularly youth. We know that the experience of homelessness disrupts the formation of healthy relationships, hinders educational and career advancement, and contributes to feelings of isolation, stigma, and hopelessness. One of the most significant challenges faced by homeless individuals, especially critical among youth, is isolation. Lacking a stable home can make it difficult to maintain social connections with family and friends, as well as form new relationships, which can lead to a sense of loneliness, disconnection, and a feeling of being "othered" from society. Homelessness is often associated with negative stereotypes and stigma and individuals experiencing homelessness face discrimination and prejudice, which can further isolate them and hinder their ability to access support and services. The stigma associated with homelessness can also lead to low self-esteem, shame, and feelings of worthlessness.

Additionally, we know that homelessness impacts a young person’s ability to be meaningfully engaged in their education. Without a stable living situation, it is very challenging to attend school regularly—lacking a stable address, reliable transportation, or lacking appropriate clothing and school-related material—complete assignments, participate in extracurricular activities. Sadly, many face discrimination and harassment in their school settings, further deterring them from continuing their education and graduating.

We also know that homelessness has a profound impact on the health and wellbeing of young people; they are at a significantly higher risk of experiencing a variety of physical and behavioral health problems, including:

Mental health challenges (such as depression, anxiety, PTSD, etc.) can be related to the trauma of homelessness itself, as well as by the underlying factors that contribute to homelessness, such as abuse, neglect, and family conflict.  Mental health challenges can have a devastating impact, causing them to withdraw from social activities, struggle in school, and experience difficulty forming and maintaining relationships; in severe cases these can also lead to suicidal thoughts and behaviors.

Homeless youth are also at a higher risk of developing substance misuse and addiction, in part due to a few factors, such as the stress and trauma of homelessness, the lack of access to healthy coping mechanisms and the influence of peers who may be using substances.

Physical health conditions, such as increased rates of chronic health conditions such as asthma, heart disease, and diabetes; nutritional deficiencies due to limited access to healthy food and food insecurity; increased exposure to infectious diseases, such as HIV/AIDS, tuberculosis, and hepatitis; accidents and injuries caused by unsafe living conditions. These physical health problems can have a profound impact on homeless youth's lives, leading to increased pain and suffering, reduced quality of life, and increased mortality rates.

Homeless youth are also more likely to experience social and emotional problems that have a devastating impact on their lives and make it very difficult for them to reach their full potential, owing to isolation, stigma, food insecurity, victimization, difficulty accessing education and employment opportunities to name a few.

It is important to note that the physical and behavioral health consequences of youth homelessness are not inevitable and with appropriate support, services and treatments, homeless youth can overcome the challenges they face and build a better future.

As health professionals we can play an important role in advocating for interventions, strategies, policies and practices that address the root causes of youth homelessness and raise awareness of the issues and educate the public about the impact of homelessness on young people's health and well-being.

Addressing the issue of youth homelessness requires a multifaceted approach that tackles the many causes of the problem, including:

  1. Addressing the physical and behavioral health consequences of youth homelessness requires a comprehensive approach that includes:

    1. Enhancing access to affordable, accessible, high-quality healthcare;

    2. Training healthcare providers to identify and address the unique needs of homeless youth; and

    3. Developing and implementing evidence-based interventions for substance use and mental health supports, services and treatment tailored to this age group.

  2. Expanding access to and/or continue Medicaid enrollment/eligibility for youth and young adults. Medicaid coverage should be expanded to include access to the full continuum of ambulatory supports, services, and treatment options, residential and inpatient treatment offerings, and enhanced peer support, crisis services, and in-home services. With thoughtful braiding of Medicaid and other federal programs States can develop affordable housing options for youth with behavioral health needs or those coming out of the foster care system.

  3. Providing family-based supports, such as counseling, conflict resolution services, and parenting education, can help strengthen families and prevent youth from running away or becoming homeless.

  4. Supporting families with financial assistance, education, and employment opportunities can help them to improve their economic stability and reduce the risk of homelessness.

  5. Expanding and creating safe, affordable housing options for young people, particularly in urban areas. Introduce the Housing First approach as an evidence-based strategy for addressing youth homelessness and/or expanding existing programs, such as the use of voucher, or creating new programs specifically for homeless youth.

  6. Identifying youth at risk of homelessness early on and providing them with support services, such as counseling, life skills training, and access to safe spaces, can help to prevent homelessness.

Youth homelessness is a critical public health issue that demands our attention. By addressing the underlying causes and providing comprehensive supports, we can work together to prevent and reduce youth homelessness. As a parent, one of my main objectives is my child’s future happiness and success, but we need to expand that goal to ensure that all young people have the opportunity to thrive, reach their full potential, and help them to build a brighter future.



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