Running head: HOMELESS ADOLESCENTS

Homeless Adolescents in America

Samantha J. Hasenzahl
Bon Secours Memorial College of Nursing

Running head: HOMELESS ADOLESCENTS

Homeless Adolescents in America

According to the 2014 Annual Homeless Assessment Report (AHAR) to Congress (U.S.
Department of Housing and Urban Development [HUD], 2014) an unaccompanied youth is any
individual under 25 years of age who is not a member of a family or multi-child household
during their period of homelessness. This population primarily comprised of people who are 1824 years old. This research also found that on a single night in January 2014 that about one-third
of all homeless people were unaccompanied youth and children. This research demonstrates that
this population is more common than many would believe. Chances are nurses, especially those
working in emergency departments, are likely to encounter a homeless youth or child at some
point in their career. Knowing what makes this population vulnerable and how to interact with
group is imperative to improving their health care and quality of life. Even though the time
nurses might spend with these clients might be small, it can leave a great impact.
This topic was chosen because adolescents and young adults tend to be overlooked. There
is a lot of research done on children, middle aged adults, and the elderly, especially in healthcare.
On the other hand, adolescents and adults are skimmed over because this is generally considered
a healthy population. However, it is critical to learn effective interventions and health strategies
for this age group because this is the time when people are establishing routines that impact their
health later on. Homeless adolescents are at even more of a disadvantage and helping this
population can have many positive results for both the individual and the community.
Social Determinants of Health
A common characteristic among homeless youth is a poor family environment (Dang &
Miller, 2013; Hudson, Nyamathi, Greengold, Slagle, Koniak-Griffen, Khalilifard, & Getzoff,
2010; Hudson, Nyamathi, & Sweat, 2008). High conflict between parents and with their parents

Running head: HOMELESS ADOLESCENTS

can lead to youth being kicked-out of their homes (Dang & Miller, 2013). The discord between
youth and their parents can lead to mistrust is authority figures which can impede on their
willingness to get help (Hudson et al., 2008). This can make seeking healthcare more difficult.
The homeless lifestyle in itself poses great risks. When compared to sheltered youth,
homeless you are more likely to use and abuse drugs and alcohol (Nyamathi et al., 2012).
Substance abuse is associated with many health issues. Sexually transmitted diseases are also
common among this population, as well as, mental illness (Hudson et al., 2008).
Homeless youth, even though they are at greater risk for health problems and injury, they
have no regular source for health care. There are many possible reasons for this, such as: no
insurance, concern of legal issues, fear of the involvement of social services, unawareness of
how health systems work, transportation issues, lack of providers, mistrust of adults, and
stigmatization (Hudson et al., 2010). Lack of health care and early interventions of many
diseases/disorders is correlated with poor outcomes.
Evidence-based Interventions Addressing Health Needs
Hudson et al.(2010) found that many homeless youth are hesitant to seek healthcare
because they have a hard time communicating with the providers, they feel they are disrespected
and treated poorly, communication is one-sided, and there is a lack of empathy. This study also
found that homeless youth want their providers to acknowledge and respect that they are experts
on their own health history, to treat them with respect, demonstrate trust, and use a
nonjudgmental approach. When working with this population, establishing trust is vital. If the
youth feels they can trust the provider they are more likely to return to get services.
Acknowledging the struggles that they face as a homeless youth is important, but should not be

Running head: HOMELESS ADOLESCENTS

the focus on the interaction. Overall this study found that an empathetic and kind approach will
improve health outcomes by establishing a trusting relationship.
To build on the previous study, Dang and Miller (2013) found that establishing a mentor
can provide many health benefits to this population. Homeless youth often lack healthy, strong
adult mentors in their life. Social support is known to be a major factor in health and well-being.
Youth who had adult mentors that they could trust were better able to cope with difficulties and
showed more resilience. Health care providers need to understand the importance of these
mentoring relationships. They should encourage these relationships and allow the youth to have
access to these mentors whether that is through phone, email, or visitation.
Nyamathi et al. (2013) examined the influence of nursing care on substance abuse in
homeless youth. They found that health promotion programs and art messaging were effective
ways to decrease substance abuse/use in this population. Youth that attended health promotion
programs about HBV/HBC and HIV decreased their use of methamphetamines, cocaine,
hallucinogens, alcohol, and marijuana. These programs focused on how these infections were
transmitted, prevention strategies, and vaccinations. The researchers suspect that these programs
were successful because they allowed the adolescents to share their experience, ask questions,
and make their own choices.
Global Approach in Addressing Health for All
Although this paper is focused on homeless youth in America, the problem is world-wide.
The good news is that the solutions are also transferrable. Nurses in any culture who use
empathy and take a nonjudgmental approach are likely to be successful in establishing a trusting
relationship with their patient. Educating patients on the potential consequences of their choices,
but also providing strategies on how to improve their situation are likely to foster change. What

Running head: HOMELESS ADOLESCENTS

is essential to the eradication of this problem, both internationally and nationally, is the
availability of resources for this population. Access to health care services and professionals is
needed in order for the needs of this population to be addressed.
Conclusion
The homeless youth population is larger than many people realize. Nurses, especially
those who work in the emergency department or mental health fields, are likely to have an
adolescent patient that is homeless. Although the interaction time may be limited, it can make a
difference. Research had shown that establishing trust, taking a nonjudgmental approach, and
having empathy can really impact the homeless youths likelihood to utilize health care services
in the future. Nurses must understand that the patient, although they are young, is the expert on
their life. Providing them with the proper education gives them the power to take control of their
health; trying to force them to do something or believe something will be fruitless and potentially
harmful.

Running head: HOMELESS ADOLESCENTS

References
Dang, M.T., & Miller, E. (2013). Characteristics of natural mentoring relationships from the
perspectives of homeless youth. Journal of Child and Adolescent Psychiatric Nursing,
26, 246-253. doi: 10.1111/jcap.12038
Hudson, A.L, Nyamathi, A., Greengold, B., Slagle, A., Koniak-Griffin, D., Khalilifard, F., &
Getzoff, D. (2010). Health-seeking challenges among homeless youth. Nursing
Research, 59(3), 212-218. doi: 10.1097/NNR.0b013e3181d1a8a9
Hudson, A.L, Nyamathi, A., & Sweat, J. (2008). Homeless youths interpersonal perspectives of
health care providers. Issues in Mental Health Nursing, 29, 1277-1289. doi:
10.1080/01612840802498235
Nyamathi, A., Branson, C., Kennedy, B., Salem, B., Khalilifard, F., Marfisee, M., Getzoff, D., &
Leake, B. (2012). Impact of nursing interventions on decreasing substances among
homeless youth. The American Journal on Addictions, 21, 558-565. doi:
10.1111/j.1521-0391.2012.00288.x
U.S. Department of Housing and Urban Development, Office of Community Planning and
Development. (2014). The 2014 annual homeless assessment report to congress: Part 1
point-in-time estimates of homelessness. Retrieved from
https://www.hudexchange.info/resources/documents/2014-AHAR-Part1.pdf