Survey: Physical Barriers, Not Fear, Keep Homeless Youth From Receiving Care

Every year, an estimated 1.6 to 1.7 million youth in the United States are living on the streets, in shelters or in other temporary living situations. Earlier studies have suggested that homeless youth do not seek medical services because of fear-based barriers – distrust of doctors, fear of being judged or misunderstood, or losing their privacy by seeking care. However, a new survey recently published in the Journal of Community Health indicates that health care barriers faced by this population are not rooted in mentality but in logistics – the top cause being lack of transportation to a medical facility.

“We thought fear-based concerns would play a bigger role in youth not seeking health care,” says Gayathri Chelvakumar, MD, member of the Adolescent Medicine Physician Team at Nationwide Children’s Hospital and lead author of the survey. “It was surprising that it was reported so infrequently. In fact, not having transportation was an even bigger issue than cost of treatment or lack of insurance.”

Dr. Chelvakumar and her team polled unstably-housed youth in three different shelters about barriers to receiving health care from a list of 14 potential choices, including “other.” The responses were then classified into three categories during analysis: lack of health insurance, logistical obstacles other than health insurance, and fear-based concerns (e.g., I don’t trust the doctor). The three most common responses – lack of transportation, lack of insurance, expense – fell under the first two categories.

Those who did report fear as a barrier to treatment utilized the emergency department 3.8 times more often than their peers in the past 12 months. This may be due to greater perceived anonymity and the common practice of not receiving medical attention until it becomes necessary.

“We’re hoping to use this survey and further work to start creating guidelines for best practices of building programs accessible to homeless youth,” adds Dr. Chelvakumar, also an assistant professor of Clinical Pediatrics at The Ohio State University College of Medicine. “Reaching these kids early can help stop homelessness now and prevent them from falling into chronic homelessness. There’s currently no system at our institution to collect routinely information on patients’ housing status, and part of the battle is identifying these kids so that we can connect them to resources.”

“We want to make health care geographically accessible, whether that’s mobile units or on-site clinics,” Dr. Chelvakumar says. “I think youth input is a big piece of starting to solve this puzzle and figuring out how to offer transportation services that will be utilized. But the good news is, these are concrete issues that we can address to make sure that everyone can find their medical home.”

Reference:

Chelvakumar G, Ford N, Kapa HM, Lange HL, McCree AL, Bonny AE. Healthcare barriers and utilization among adolescents and young adults accessing services for homeless and runaway youth. Journal of Community Health. 05 Nov 2016. [Epub ahead of print]