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Service Delivery Innovation Profile

Easily Accessible, Welcoming Center Enhances Access to Medical and Social Services for Lesbian, Gay, Bisexual, and Transgender Homeless Youth


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Snapshot

Summary

A program of Howard Brown Health Center and its community partners, Broadway Youth Center offers a wide array of social and medical services to homeless and underserved youth, especially those who identify as being lesbian, gay, bisexual, or transgender. This easily accessible, "one-stop shop" eliminates most barriers to care by offering services free of charge and not requiring an appointment or identification. Center services seek to meet the complex needs of these at-risk youth within a safe, welcoming, nonjudgmental environment, including basic necessities, routine medical care, testing and counseling for human immunodeficiency virus and other sexually transmitted diseases, discussion groups, mental health counseling, case management, and career training. The program has successfully connected thousands of hard-to-reach, disenfranchised youth with badly needed services. The vast majority of these youth would not have had access to these services in the absence of this program.

Evidence Rating (What is this?)

Suggestive: The evidence consists of post-implementation data on the number of youth served, including those who received STD and HIV testing, HIV prevention programming, and HIV treatment. The underlying assumption is that, in the absence of this program, the vast majority of these youth would not have been able to access these services.
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Developing Organizations

Children's Memorial Hospital; Howard Brown Health Center; Teen Living Programs; The Night Ministry; Tides Foundation
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Date First Implemented

2004
The center originally opened in 1994, offering a limited set of services 1 night a week. In 2004, a new, expanded center opened offering a broader array of services 5 days per week. The program started offering weekend hours in 2005 and is now open 6 days a week.begin ppxml

Patient Population

The program serves at-risk youth between the ages of 12 and 24, especially those who identify as LGBT or as questioning their sexual or gender identity.Age > Adolescent (13-18 years); Vulnerable Populations > Homeless; Lesbian/gay/bisexual/transgender; Urban populationsend pp

Problem Addressed

Up to 2 million youth in the United States are homeless, with lesbian, gay, bisexual, or transgender (LGBT) youth being disproportionately likely not to have a home. Although all homeless youth face health risks, homeless LGBT youth are at even greater risk for various health problems, including human immunodeficiency virus (HIV), other sexually transmitted diseases (STDs), and mental health issues. These youth also face significant barriers to accessing medical and social services that can help avoid and/or treat these problems.
  • Many homeless youth, especially within LGBT community in large cities: Approximately 1.5 to 2 million homeless youth live in the United States.1 LGBT youth face a disproportionate risk of being homeless—they represent between 20 and 42 percent of all homeless youth, but only 5 to 10 percent of the overall population.2 Runaway and homeless youth tend to congregate in large cities. In Illinois, for example, an estimated 25,000 youth experience homelessness each year, 12,000 to 15,000 of whom live in Chicago.3
  • More likely to engage in risky behaviors: Homeless individuals in general—and homeless LGBT individuals in particular—are more likely to engage in risky behaviors that can harm their health, as outlined below:
    • Greater use of “hard” drugs: Between 10 and 20 percent of homeless youth identify themselves as having a chemical dependency.2 Use of injectable drugs may be as high as 56 percent.1 LGBT youth may be more likely to use “harder” drugs than heterosexual youth, including cocaine, crack, crystal methamphetamines, or combinations of these drugs.4
    • Riskier sexual behaviors: Although nearly all homeless youth are sexually active, LGBT youth report more than twice as many lifetime partners, a younger age for first voluntary intercourse, and less use of protection during sex.4 A study conducted at Howard Brown found that 44 percent of homeless LGBT youth have engaged in unprotected anal sex, while 50 percent have used drugs or alcohol while having sex.5 In some cases, LGBT homeless youth engage in “survival sex" (i.e., the exchange of sex for food, money, clothes, a place to stay, and/or drugs).
  • Higher incidence of health problems: Engaging in risky behaviors and living on the streets put homeless LGBT youth at increased risk of various health problems, including, but not limited to, the following:
    • HIV: HIV infection rates are rising among young people, especially gay and bisexual men.6 Homeless youth face a 2 to 10 times greater prevalence of HIV than other groups of adolescents.7
    • Mental health issues: LGBT youth report higher levels of depressive symptoms than do their peers, including withdrawn behavior, psychosomatic complaints, and social problems.4
  • Significant barriers to medical and social services: All homeless youth face barriers to accessing medical and social services that can help to prevent and treat these problems. For example, although an estimated 1,000 homeless youth live on the streets of Chicago each night, only 50 shelter beds are earmarked for youth.8 LGBT homeless youth face especially large barriers to accessing needed services due to discrimination and alienation caused in large part by the stigma society attaches to their sexual orientation and homelessness.2 Many LGBT people do not feel welcome at traditional social service agencies serving the general homeless population. In addition, homeless youth often feel out-of-place in shelters or agencies serving adults.

What They Did

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Description of the Innovative Activity

A program of Howard Brown Health Center and its community partners, Broadway Youth Center offers a wide array of social and medical services to homeless and underserved youth, especially LGBT individuals. This easily accessible, "one-stop shop" eliminates most barriers to care by offering services free of charge and not requiring an appointment or identification. Center services seek to meet the complex needs of these at-risk youth within a safe, welcoming, nonjudgmental environment, including basic necessities, routine medical care, testing and counseling for HIV and other sexually transmitted diseases, discussion groups, mental health counseling, case management, and career training. Key elements of the program include the following:
  • One-stop shop for full range of services: The center offers basic necessities, social services, and medical services together in a central, easily accessible location. Slightly more than half of the 80 to 90 youth who drop in daily originally come to the center to fill an immediate need, such as clean clothes, a healthy meal, or a nap in a safe place. As these youth get comfortable and establish trust with the staff, they often begin to take advantage of the center's other offerings, including medical and social services.
  • Few if any barriers to care: The center seeks to eliminate as many barriers as possible to at-risk youth receiving services. To that end, the center offers all services free of charge and does not require an appointment or that the youth show any identification. In addition, the center's permanent site—located in an easily accessible area near where homeless youth congregate—operates Monday to Friday from 1 p.m. to 8 p.m. and on Saturday from 1 p.m. to 4 p.m.
  • Comprehensive array of services: The center offers a comprehensive array of services, including basic necessities, routine medical services, HIV testing and counseling, and social services, as outlined below:
    • Basic necessities: Youth can drop in 5 days a week for meals, hygiene supplies, showers, clothing, laundry services, and access to computers, e-mail, and phones. They can also receive voice mail accounts and storage lockers.
    • Routine medical care: Broadway Youth Center provides confidential, adolescent-specific medical care during clinics offered 3 days a week, with no appointment being necessary. Services include STD diagnosis and treatment, family planning, cold and flu treatment, wound care, and health education. Youth who need ongoing primary care receive a referral to Howard Brown Health Center, where they pay for such care based on a sliding scale.
    • Peer-based HIV testing and counseling: Because youth engage more easily and establish trust faster with counselors and staff who look and sound like themselves, the center offers HIV testing and counseling by staff with a similar demographic as those they serve. Although the testing and counseling process varies according to individual needs and preferences, the core elements include precounseling, rapid HIV test, and postcounseling, as outlined below:
      • Pretest counseling: Before administering an HIV test, a staff counselor asks basic questions to assess the person’s knowledge about HIV and HIV prevention. Counselors then go over current behaviors and work with the youth to develop an appropriate risk-reduction plan based on the behaviors the youth would like to change.
      • Rapid test: The counselor administers an oral, rapid HIV test, with results being ready within 20 minutes.
      • Posttest counseling: A case manager trained in crisis management meets with youth identified as HIV positive, with the goal of connecting him/her to ongoing medical care at Howard Brown Health Center. If the youth does not want to speak to the case manager at this time, contact information is forwarded to the case manager for followup. Youth who test as HIV-negative talk with a counselor about strategies to reduce risk and receive referrals they may need for medical or other services; referrals for primary care are most common.
    • Youth-centered discussion groups: The center offers a variety of HIV prevention groups for youth at particularly high risk of infection. These discussion groups center on issues and interests that the youths themselves suggest, with a focus on reducing risky behaviors. The center also offers free condoms and other safe-sex supplies at these sessions.
    • Easy-to-access mental health counseling: Youth in crisis and those who otherwise want to talk can interact with a licensed clinical social worker during drop-in hours. Those ready to make a commitment to ongoing therapy can access structured appointments before and after the drop-in hours. Although many traditional counseling programs have long waiting lists, the center completes the intake process and sets up the first appointment within 1 week.
    • Resource advocacy/case management: Resource advocates provide one-on-one, intensive nonjudgmental support to help young people navigate the health care system, apply for government benefits, obtain treatment for mental health issues, procure housing, seek employment, and pursue educational opportunities. Case management represents a partnership between youth and staff, recognizing that young people remain the experts on their own lives, but need support to navigate complicated systems. Case management services can be accessed during regular center hours or through appointments at other times.
    • Career training, placement, and other youth development services: The center encourages youth to work towards economic empowerment through career training, tutoring for the General Educational Development or GED test, job placement, and other youth development services.
    • Social activities and workshops: The center offers social activities and workshops during drop-in hours. Many workshops incorporate artistic expression—writing, painting, drawing, performing—as a way to communicate with youth, encourage self-discovery, and build trust with center staff. Workshop participants receive public transit cards or other incentives for taking part in these programs.

Context of the Innovation

With an annual budget of more than $13 million, Howard Brown Health Center serves more than 36,000 adults and youth each year, primarily LGBT individuals. Its diverse health and social service delivery system focuses on primary medical care, behavioral health, research, HIV/STD prevention, case management, social services, youth services, older adult services, and community initiatives. To serve the medical needs of youth, Howard Brown works with staff from Children’s Memorial Hospital, a 270-bed hospital specializing in pediatric care and providing care in 70 different pediatric specialties to 140,000 children each year.

The Broadway Youth Center provides Chicago's LGBT homeless youth (which number somewhere between 1,500 and 3,000 individuals3) a safe, welcoming, nonjudgmental place to receive needed medical and social services. These youth often faced abuse and neglect at home, bullying at school or in the community, and a feeling of isolation and alienation from the rest of society. Although running away from home or living on the streets may offer an escape from these challenges, it creates another set of risks that endanger the health of these youth. The Broadway Youth Center was conceived as a place to address these challenges and risks, and the Lakeview East area of the city represented a natural place for the center because the area serves as a gathering place for homeless youth.

Did It Work?

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Results

The Broadway Youth Center has successfully connected thousands of hard-to-reach, vulnerable youth with badly needed services, particularly HIV and STD testing and HIV treatment. The vast majority of these youth would not have had access to these services in the absence of this program.
  • Many served: In fiscal year 2010, 5,325 youth visited the center for drop-in services, HIV testing, HIV prevention programs, case management, and counseling.9 Since becoming a 7-day-a-week operation in 2004, the center has served more than 20,000 youth and has become the largest provider of HIV testing and counseling to youth in Illinois.
  • Expanded access to STD testing: In fiscal year 2010, nearly 900 youth completed more than 1,200 medical visits, including 430 youth treated for STDs, including chlamydia, gonorrhea, and syphilis.9
  • Expanded access to HIV prevention and testing: Nearly 2,000 youth participate in HIV prevention programming annually.9 Each year, between 1,500 and 2,000 youth get tested for HIV at the center.
  • 100-percent success connecting to HIV treatment: On average, 1.4 percent of those screened for HIV at the center test positive, well above the national average of less than 1 percent. Over the life of the program, approximately 90 percent of youth who tested positive were successfully connected to ongoing HIV care at Howard Brown Health Center. In 2010, 195 HIV-positive youth completed 1,037 primary care visits at Howard Brown. Many also received case management, psychotherapy, and other services through the center and Howard Brown.9

Evidence Rating (What is this?)

Suggestive: The evidence consists of post-implementation data on the number of youth served, including those who received STD and HIV testing, HIV prevention programming, and HIV treatment. The underlying assumption is that, in the absence of this program, the vast majority of these youth would not have been able to access these services.

How They Did It

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Planning and Development Process

Key steps included the following:
  • Developing community partnerships: Robert Garofalo, MD, MPH, a pediatrician at Children’s Memorial Hospital, and Joe Hollendoner, MSW, then a program manager at Howard Brown Health Center, realized that they needed to join forces with community organizations that specialized in offering nonmedical support services (to supplement their organization's ability to provide medical services). To that end, they approached and partnered with the following community-based organizations:
    • The Night Ministry of Chicago: A nondenominational, nonprofit organization that offers case management and outreach, youth housing programs, and pregnancy and parenting support to youth and adults facing homelessness, poverty, abuse, or neglect.
    • Teen Living Programs: An organization offering housing, job training, educational support, mental health counseling, holistic health care, and life-skills training to homeless and at-risk teens in Chicago.
  • Initial launch on small scale: Since 1994, Howard Brown Health Center had operated a one-night-a-week drop-in program for LGBT youth offering HIV testing, counseling, and prevention programming, along with space for these youth to gather and socialize. The drop-in center eventually expanded and relocated to become the Broadway Youth Center.
  • Building larger center to meet increasing, changing needs: Over the next 10 years, the drop-in program attracted increasing numbers of youth as the population of LGBT youth grew and word spread about the center's high-quality services. At the same time, several other local social service programs aimed at youth closed. Consequently, center staff found it difficult to keep up with the growing demands, and often had difficulties connecting youth to the services they needed. Staff felt they no longer had time to deliver quality care or the intensity of services needed by participants. To address this issue, program leaders decided to build a larger, central facility offering a broader array of daily services.

Resources Used and Skills Needed

  • Staffing: Many people working in the Broadway Youth Center are employees of different community partners that bring services and programs to the center. The center employs roughly 18 full- and part-time staff, including 3 case managers (2 bachelor's-level, 1 master's-level), 1 drop-in coordinator and 2 drop-in staff (bachelor's-level), 1 licensed social worker, 1 clinic coordinator (a nurse practitioner), 1 physician, physician assistant, and nurse practitioner (all part-time), 1 GED instructor, 1 training manager, 6 HIV prevention staff to run discussion groups and projects, and 2 administrative staff (manager and receptionist).
  • Costs: The center's 2010 budget totaled $1.6 million, of which $300,000 came from Howard Brown’s general budget. In fiscal year 2011, Howard Brown could no longer contribute that extra funding, which cut the annual budget to $1.3 million. Broadway Youth Center has been able to sustain core services even with these budget cuts. The program also receives in-kind support from partner organizations and community agencies. To deliver the same services without such support, the total annual budget would need to be between $2 and $2.5 million.
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Funding Sources

Centers for Disease Control and Prevention; Health Resources and Services Administration; VNA Chicago Foundation; Chicago Department of Public Health; The Night Ministry; Children's Memorial Hospital; University of Illinois-Chicago; Inspiration Corporation; UCAN; First Slice; McDermott, Will & Emery; About Face Theatre; Beyondmedia Education; Designs for Dignity; PFLAG Chicago; Illinois Safe School Alliance; Counseling Center of Lake View; Prologue Alternative High School; Teen Living Programs; Chicago Department of Family and Support Services; After School Matters; United Way of Metropolitan Chicago; Polk Bros Foundation; The Lifeboat Foundation; Elizabeth Morse Charitable Trust; Ameriprise Financial; Blowitz Ridgeway Foundation; People's Gas; Siragusa Foundation; MB Financial Bank; George M. Eisenberg Foundation; TCF Bank; Crossroads Fund; Steamworks; Tides Foundation
Sixteen community partners provide staff and/or funding to the Broadway Youth Center:
  • The Night Ministry (drop-in staff, group facilitators, housing linkages, and referrals)
  • Teen Living Programs (housing referrals)
  • Children’s Memorial Hospital (medical providers, drop-in workers, HIV testers, research, hospitalization)
  • Prologue Alternative High School (GED teacher and program support)
  • University of Illinois-Chicago (research collaborator)
  • Inspiration Corporation (career training and voice mail)
  • UCAN (host home program)
  • First Slice (meal services)
  • McDermott Will & Emery (legal services)
  • Chicago Department of Public Health (HIV/STD testing and treatment resources)
  • About Face Theatre (arts-based programming)
  • Beyondmedia Education (arts-based programming)
  • Designs for Dignity (center renovation)
  • PFLAG Chicago (family support programming)
  • Illinois Safe School Alliance (school advocacy)
  • Counseling Center of Lake View (drop-in staff, mental health referrals)

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Adoption Considerations

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Getting Started with This Innovation

  • Work with existing community resources: Although the concept originated within Howard Brown, the center required services and skills not available within that organization. By partnering with others with expertise and experience in these areas (e.g., serving runaway youth, offering job training and placement) and offering a variety of services in one location, the program became more than just the sum of its parts.
  • Build on preexisting relationships: The most difficult moments in any collaborative process stem from lack of trust among the participating organizations. Because Howard Brown staff already had relationships with people and programs in other organizations, the partners could work through tough decisions based on mutual trust and respect.
  • Allow one organization to take lead: The initial plan did not call for ownership of the Broadway Youth Center by any one organization. However, this approach created difficulties related to funding, stability, recognition, and decisionmaking. Over time, it became apparent that one organization had to take ownership of the program, and hence the center is now clearly associated with Howard Brown.
  • Test concept in pilot program: Operating the once-a-week drop-in program for 10 years gave program leaders the time and experience necessary to expand the program successfully.

Sustaining This Innovation

  • Add partners based on needs, common mission: Additional community partners should fill a specific need, such as staff or resources. The partner’s mission should also dovetail with that of the program, and its services should cater to the needs and preferences of the population being served.
  • Encourage shared culture: Broadway Youth Center has its own culture distinct from that of its community partners, including the rest of Howard Brown. Everyone who works at the center, including center employees and those working for Howard Brown and other partners, attends a site-specific orientation that provides an understanding of Broadway Youth Center's culture. This orientation not only builds a more cohesive staff, but also makes the various services appear seamless to the youth being served, who view all services as being part of the center.
  • Grow cautiously: Program leaders will naturally want to expand services to meet growing community needs. However, growing too quickly or moving away from the easy-to-access service model can cause problems. Consequently, programs should begin with a base set of services and then expand strategically over time based on specific client needs.
  • Refine services to focus on high-impact areas: Broadway Youth Center used to offer HIV testing at 30 different venues, including colleges, universities, and other places where youth gathered. But they identified only five or six new HIV cases per year. Due to budget cuts, center leaders reduced the number of testing sites. Now the center offers testing at five locations that serve those at highest risk (determined by the positivity rate for testing at those sites). The center performs twice as many tests in these locations, and identifies four to five times as many new HIV cases each year.
  • Strategically use research projects to fund, expand offerings: LGBT youth are often under-represented in HIV prevention and other medical research. To address this issue, Broadway Youth Center gives Howard Brown and Children’s Hospital the opportunity to develop and evaluate programs that benefit clients now and add to the body of knowledge about HIV and youth. Center leaders carefully choose the research projects in which they participate, making sure the program is practical and in tune with the center's mission. Successful programs become integrated into ongoing offerings and hence live beyond the life of the research grant. Research funding has helped to pay for medical and other services that had recently been cut due to budget constraints.
  • Be an educational resource to others with common goals: As possible, Broadway Youth Center honors requests from those who want to volunteer, intern, or train at the center. Providing this opportunity not only enhances center services, but also helps to ensure that the center's reach goes beyond the immediate community.
  • Listen to clients: To keep the program acceptable and accessible to youth, regularly elicit feedback from clients and potential clients about the program, including whether and how it meets their needs and any problems they may be facing. Refine offerings as necessary and practical based on this feedback.

More Information

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Contact the Innovator

Lara Brooks
Director of the Broadway Youth Center
Howard Brown Health Center
4025 N. Sheridan Road
Chicago, IL 60613
Phone: (773) 299-7622
Email: larab@howardbrown.org

Innovator Disclosures

Ms. Brooks has not indicated whether she has financial interests or business/professional affiliations relevant to the work described in this profile; however, information on funders is available in the Funding Sources section.

References/Related Articles

National Coalition for the Homeless. Fact Sheet #13, Homeless Youth (August 2007) Available at http://www.nationalhomeless.org/publications/facts/youth.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat ReaderĀ® software External Web Site Policy.).

Ray N. Lesbian, gay, bisexual and transgender youth: an epidemic of homelessness. New York: National Gay and Lesbian Task Force Policy Institute and the National Coalition for the Homeless; 2006. Available at: http://www.thetaskforce.org/downloads/HomelessYouth.pdf.

Footnotes

1 Hudson AL, Nyamathi A, Greengold B, et al. Health-Seeking Challenges Among Homeless Youth. Nurs Res. 2010;59(3):212-218. [PubMed] Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2949422.
2 Ray N. Lesbian, gay, bisexual and transgender youth: An epidemic of homelessness. New York: National Gay and Lesbian Task Force Policy Institute and the National Coalition for the Homeless; 2006. Available at: http://www.thetaskforce.org/downloads/HomelessYouth.pdf.
3 National Gay and Lesbian Task Force. Fact sheet: Homeless lesbian, gay, bisexual and transgender (LGBT) youth in Chicago, Ill. Available at http://www.thetaskforce.org/downloads/reports/fact_sheets/HomelessYouthChicago012507.pdf.
4 Cochran BN, Stewart AJ, Ginzler JA, et al. Challenges faced by homeless sexual minorities: comparison of gay, lesbian, bisexual, and transgender adolescents with their heterosexual counterparts. Am J Pub Health.2002:92(5):773-777. [PubMed] Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447160.
5 Broadway Youth Center Proposal to Polk Bros Foundation for Services
6 Centers for Disease Control and Prevention. HIV Incidence, August 2011. Available at: http://www.cdc.gov/hiv/topics/surveillance/incidence.htm.
7 National Coalition for the Homeless. Fact Sheet #13, Homeless Youth (August 2007). Available at: http://www.nationalhomeless.org/publications/facts/youth.pdf.
8 Community Activist Honored for Creating Programs to Assist LGBT Youth in Chicago; Thousands Served Each Year, Available at: http://www.communityhealthleaders.org/news_features/pr/72526.
9 Broadway Youth Center: Program Outputs for Fiscal Year 2010
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Disclaimer: The inclusion of an innovation in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, or Westat of the innovation or of the submitter or developer of the innovation. Read more.

Original publication: March 16, 2011.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: July 17, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: January 06, 2011.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.