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February 2013
Chats on Change: Supporting At-Risk LGBT and Homeless Youth
Thank you for participating in the Chat on Change held February 27, 2013. During the TweetChat, we were joined by Lara Brooks from the Broadway Youth Center in Chicago, IL. The Innovations Exchange also provided several examples of relevant innovations during the Chat.
Lara Brooks is the Director of the Broadway Youth Center (BYC) and has worked with street-based and homeless youth, survivors of violence, and LGBT youth for more than a decade. The BYC, a program of Howard Brown Health Center and its community partners, uses a comprehensive, “one-stop-shop” model that offers integrated services to LGBT youth, youth experiencing homelessness and housing instability, and street-based youth. These services include (1) medical services; (2) crisis intervention counseling and psychotherapy; (3) resource advocacy/case management services (linking youth to programs that help meet their more complex basic needs, like housing, public benefits and state-issued identification); (4) HIV/STI testing, outreach, and prevention programs; (5) basic need drop-in services (i.e., food, showers, hygiene supplies, clothing, laundry, etc.); and (6) tutoring sessions for youth interested in obtaining a GED high school equivalency diploma.

Paying special attention to the intersection of trauma, harm reduction, oppression and resilience, Brooks speaks locally and nationally on issues related to LGBT intimate partner and sexual violence; harm reduction; alternatives to policing; and community accountability/transformative justice. As a former board member for the Young Women’s Empowerment Project, Lara continues her support as an adult ally. Brooks is currently on the Community Advisory Council for Sage Community Health Collective, a Chicago-based healing justice worker collective that offers sliding scale payment options for alternative health care.


Our TweetChat on improving #HIV & #STD screenings for #LGBT homeless youth with Lara Brooks of @hbhclifeline is about to begin! #AHRQIX

AHRQIX: We’re using #AHRQIX for the chat. Please include it in your tweets. #AHRQIX

AHRQIX: If you have a question and want to tweet during the chat, be sure your tweets are not protected. #AHRQIX

AHRQIX: We may collect, save, & post transcripts from monthly chats on our Web site. See our privacy policy at #AHRQIX

AHRQIX: Lara will be tweeting along with us @hbhclifeline, so please follow the stream of tweets at #AHRQIX

AHRQIX: If you’re having problems viewing the TweetChat site, you can also follow the live stream by searching on Twitter for #AHRQIX. #AHRQIX

AHRQIX: The focus of this chat is improving #HIV & #STD screenings for LGBT homeless youth. Please be respectful of others during the chat. #AHRQIX

AHRQIX: Welcome to our TweetChat on improving #HIV & #STD screenings for #LGBT homeless youth! I’m Nicole & I’ll be moderating the chat. #AHRQIX

AHRQIX: I’m pleased to be joined by Lara Brooks, Director of the Broadway Youth Center (BYC), a program of @hbhclifeline & its partners. #AHRQIX

AHRQIX: Please note the Innovations Exchange does not provide advice on health-related issues or experiences. #AHRQIX

AHRQIX: We’ll ask/answer questions w/ @hbhclifeline & participants, as well as share resources on #HIV & #STD screenings & #LGBT healthcare #AHRQIX

AHRQIX: When did the BYC open and who were its founding members? #AHRQIX

hbhclifeline: The BYC opened in 2004 through the amazing vision of four organizations. #ahrqix

hbhclifeline: These included: HBHC, The Night Ministry, Teen Living Programs, and Ann & Robert H. Lurie Children's Hospital of Chicago. #ahrqix

hbhclifeline: These founders combined expertise in LGBTQ health and homeless youth services to launch a comprehensive, 'one-stop-shop' model. #ahrqix

AHRQIX: .@hbhclifeline, what's the purpose of the BYC? #AHRQIX

hbhclifeline: We serve youth, ages 12-24, who are experiencing homelessness, housing instability, and/or are LGBTQ-identified. #ahrqix

AHRQIX: For those of you joining us today, please ask questions -- @hbhclifeline is here to answer! #AHRQIX

hbhclifeline: We try to make our services as accessible as possible, using a harm reduction model of care. #ahrqix

FieldsTom: Approximately how many youth do you provide services to annually? #ahrqix

hbhclifeline: We served about 3,000 unique youth in 2012 and provided more than 20,000 contacts during that time. Services include... #ahrqix

hbhclifeline: basic needs drop-in services, walk-in clinic, STI/HIV testing, counseling, homeless youth case management, and an LGBT GED program. #ahrqix

AHRQIX: Here is the BYC's innovation that we are talking about today.… #AHRQIX

hbhclifeline: About 1,200 youth come through our walk-in sexual health clinic as well, making us one of the largest providers of STI dx/treatment. #ahrqix

SexualityLab: Did you know? 20 and 42 percent of all #homelessyouth are #LGBT, but only 5 to 10 percent of the overall population is LGBT. #AHRQIX

hbhclifeline: These numbers reflect what we're seeing at the BYC. In fact, about 20% of youth accessing homeless youth services are transgender. #ahrqix

illadelphgirl: how many providers work at the health services clinic? #AHRQIX

hbhclifeline: In our sexual health clinic, about 70% of our patients are LGBTQ. #ahrqix

hbhclifeline: Our clinic is operated by one full-time RN who is incredible! We are supported by mid-level providers for 2.5 hour/week. #ahrqix

HassellS: I'm interested to hear more about the harm reduction model- I'm not familiar with that. #AHRQIX

hbhclifeline: Harm reduction is a model that meets people where they are at, without judgement. HR respect self-determination. #ahrqix

hbhclifeline: HR incorporates safety planning, harm/risk reduction, and emphasizes long-term relationship building. #ahrqix

hbhclifeline: Some great information on this modality can be found at #ahrqix

AHRQIX: Here is the model that @hbhclifeline is referencing: #AHRQIX

AHRQIX: In addition to the Q&A, we'll share some related innovations that are featured on our website during this event. #AHRQIX

hbhclifeline: Check out the link to our model of care at the BYC. It centers the importance of engaging youth in basic needs services... #ahrqix

hbhclifeline: as a tool to engage youth in more 'traditional' models of care, like therapy, case management, and medical services. #ahrqix

AHRQIX: .@UCSFHospitals implemented policies for culturally competent care to LGBT patients, making them feel safer #AHRQIX

SexualityLab: RT @ahrqix: Here is the model that @hbhclifeline is referencing: #AHRQIX

AHRQIX: What are some of the tools/resources that healthcare systems or clinicians should know about? #AHRQIX

hbhclifeline: Many tools inform our work. These include participatory action research studies on institutional violence from a community partner. #ahrqix

HassellS: Thank you, I look forward to reading about this more. How do you reach your target population and let them know about your services? #AHRQIX

hbhclifeline: Check out the Young Women's Empowerment Project at for results of the Bad Encounter Line. #ahrqix

SexualityLab: RT @hbhclifeline: Harm reduction is a model that meets people where they are at, without judgement. HR respect self-determination. #ahrqix

hbhclifeline: We've learned a lot from youth who have had negative experiences accessing health care due to stigma. #ahrqix

SexualityLab: RT @hbhclifeline: HR incorporates safety planning, harm/risk reduction, and emphasizes long-term relationship building. #ahrqix

AHRQIX: Participants: What is your experience w/ healthcare providers/clinics addressing the needs of LGBT youth experiencing homelessness? #AHRQIX

SexualityLab: RT @hbhclifeline: Some great information on this modality can be found at #ahrqix

hbhclifeline: We use trauma-informed frameworks to enhance the work--knowing that many street-based youth are engaged in the sex trade, etc. #ahrqix

hbhclifeline: HBHC also has an accessible hormone protocol called THInC, a model based on informed consent. #ahrqix

hbhclifeline: Here's the link to some FAQs:… #ahrqix

SexualityLab: In our UHIP study, 17% of sample of young MSM & transwomen in Detroit Metro area spent >= 1 night in last month homeless/transient #AHRQIX

AHRQIX: Lara, what advice do you have for HCPs/clinics on improving access for LGBT youth & youth experiencing homelessness? #AHRQIX

hbhclifeline: This is our advice: Low-threshold means minimizing registration forms and identification requirements. #ahrqix

hbhclifeline: We also love our walk-in model because youth can access us when they need us. #ahrqix

hbhclifeline: We are also really effective at engaging hard-to-reach youth because we are incredibly relationship based. #ahrqix

hbhclifeline: It's also really important to train reception staff--and to see the entire team as a group of youth workers, first and foremost. #ahrqix

AHRQIX: The @REALtalkDC campaign targets DC youth & provides HIV, LGBT, STD & other health info online & via text #AHRQIX

hbhclifeline: It's amazing to have a clinic with one main nurse--it really feels like the continuum of care you would receive from a PCP. #ahrqix

hbhclifeline: Another best practice: Using gender neutral language and asking youth to self-identify needs--without us placing labels on them. #ahrqix

AHRQIX: Lara, who are some of the community partners you work with at BYC? #AHRQIX

hbhclifeline: Our community partners really ground the work. Some ones we would like to highlight include: Young Women's Empowerment Project. #ahrqix

hbhclifeline: YWEP provides a peer-based syringe exchange for youth injecting drugs and/or injecting hormones. #ahrqix

hbhclifeline: We also collaborate with The Night Ministry. They build relationships with youth through street-based outreach efforts... #ahrqix

hbhclifeline: Additionally, TNM houses many LGBTQ youth through low-threshold shelter called the Crib. #ahrqix

hbhclifeline: We also collaborate with theTransformative Justice Law Project ( to connect youth with name change advocates. #ahrqix

miller7: @hbhclifeline How are you all documenting some of your great work? How do you evaluate your efforts? #ahrqix

hbhclifeline: Another amazing partner is the Youth Empowerment Performance Project, an LGBTQA youth theater project. #ahrqix

SexualityLab: You can learn more about our UHIP study here & here #AHRQIX

hbhclifeline: We document our programs through electronic health records. #ahrqix

hbhclifeline: We also evaluate our programs through weekly youth-led community meetings (with youth and staff). #ahrqix

hbhclifeline: We have written a few documents about our violence prevention efforts as well. #ahrqix

hbhclifeline: Here's the link:… #ahrqix

miller7: @hbhclifeline It would be great if you could share those links! Thanks! #ahrqix

AHRQIX: Lara, what does a ‘medical home’ look like for #LGBT youth and youth experiencing homelessness? #medicalhome #AHRQIX

hbhclifeline: For us, a youth-centered medical home means having as many supportive services onsite as possible. #ahrqix

hbhclifeline: Success for us means a young person accessing everything from GED session to an apt with our nurse to dx/treat an STI in one visit. #ahrqix

miller7: @hbhclifeline Onsite services are highly innovative but also costly. How do you financially support your innovations? #ahrqix

hbhclifeline: We've reduced costs by using a nurse-led clinic--and it's produced amazing results. #ahrqix

hbhclifeline: We also generate revenue through a really diverse portfolio of funders (everything from corporate/foundation to City funding). #ahrqix

AHRQIX: .@ISISorg & @SanFranciscoDPH have a texting program to raise awareness/concern about STDs among at-risk youth #AHRQIX

illadelphgirl: are there any costs for the youth who access services? #AHRQIX

hbhclifeline: All of services and treatment are free of charge. Amazing! #ahrqix

AHRQIX: .@hbhclifeline, how do you reach homeless youth to let them know your services are available? #AHRQIX

hbhclifeline: In the past 8 years, we've done very little outreach. Youth with positive experiences are the best kind of marketing. #ahrqix

hbhclifeline: Word also travels fast in the street-based LGBTQ youth community. #ahrqix

hbhclifeline: Youth also learn about us through The Night Ministry's street outreach efforts. #ahrqix

illadelphgirl: how did you recruit youth to participate in the weekly community meetings? do you provide incentives? #AHRQIX

AHRQIX: We’ll be closing the live chat in 10 mins. Does anyone have any questions for @hbhclifeline before our time is up? #AHRQIX

hbhclifeline: The drop-in youth community participate in weekly community meetings to provide feedback. We offer incentives for facilitators. #ahrqix

hbhclifeline: We have about 40 youth who participate in these meetings--just to provide a context. #ahrqix

AHRQIX: .@hbhclifeline, what are some of the services that you offer? #AHRQIX

hbhclifeline: To learn more about our services, check out:… #ahrqix

hbhclifeline: We have about 17 staff operating all of our programs and services--as well as 20+ active volunteers. #ahrqix

hbhclifeline: About 18 different community partners also contribute to our day-to-day operations. #ahrqix

FieldsTom: What mental health services do you provide? #ahrqix

hbhclifeline: We could not do this innovative work without the support of our community. Donations, like hygiene supplies, support homeless youth. #ahrqix

hbhclifeline: We provide therapy services, an LGBT GED (Vocation/Education) program, homeless youth case management services, and HIV/STI testing. #ahrqix

hbhclifeline: Drop In services include youth-led programming, food, showers, hygiene supplies, clothing, transit assistance, and access to tech #ahrqix

hbhclifeline: Our therapist also spends time in the drop-in program providing crisis intervention support and services. #ahrqix

AHRQIX: .@crewsnhealth operates a free-standing clinic & mobile medical unit for #Arizona's homeless & at-risk youth. #AHRQIX

hbhclifeline: This reduces barriers around therapy--which has proven effective in engaging youth. #ahrqix

hbhclifeline: We also offer evening programs. For example, TYRA--a program for transgender and gender non-conforming young people. #ahrqix

AHRQIX: This program enhanced access to care by providing web-based health info & service to homeless & runaway youth #AHRQIX

AHRQIX: One last question for Lara: How can you model be adopted in other communities? #AHRQIX

FieldsTom: RT @hbhclifeline: We provide therapy services,LGBT GED (Vocation/Education) program, homeless case management, and HIV/STI testing. #ahrqix

hbhclifeline: I think the BYC is an important model that can be replicated and adapted for different communities, esp. those exp. homelessness. #ahrqix

hbhclifeline: The BYC proves that collaborations DO work--and that we can pull together 'experts' in various services to increase our impact. #ahrqix

hbhclifeline: This model truly depends on being clear about what your center is: In this case, it's LGBTQ youth experiencing homelessness. #ahrqix

hbhclifeline: All of our decisions, program designs, and collaborating partners revolve around that center. #ahrqix

AHRQIX: Thank you to everyone who joined & participated in our TweetChat today! You can review the archive using #AHRQIX after the event #AHRQIX

illadelphgirl: RT@hbhclifeline:proves that collaborations DO work-and that we can pull together experts in various services to increase our impact. #AHRQIX

AHRQIX: Feel free to continue sharing questions, info, and what’s working for you via Twitter @AHRQIX & @hbhclifeline #AHRQIX

AHRQIX: And a special thanks to Lara Brooks for providing great information! We’re so glad you were able to join us today! @hbhclifeline #AHRQIX

rosecasanova: Join in the tweetchat about innovations in healthcare #ahrqix

rosecasanova: I have used @hbhclifeline services in Chicago. Everyone there is really nice. Thanks for being there when I had no insurance and $. #ahrqix

How to Join the TweetChat

NOTE: To join the TweetChat, you must have a Twitter account.

If you don’t already have an account, follow these simple instructions to get started. Setting up your account should only take 1-2 minutes at the most.

If you do have an account on Twitter, you can skip to Step 2: Joining the TweetChat.

Step1: Signing up for Twitter

1. Open your browser to the URL External Web Site Policy or click through now with the hyperlink given.

Text description follows

You should see this page. Complete your details in the lower box titled: New to Twitter and then click the yellow button: Sign up for Twitter.

2. The following window External Web Site Policy opens next. Complete the remaining account details and click the yellow button: Create my account.

3. Once your account is created, Twitter takes you to a setup page. Bypass this page by typing External Web Site Policy in your browser. This takes you to your newly created Twitter home page. See below.

4. Note that Twitter sent you an email confirmation to activate your account. This confirmation was sent to the account with which you registered. Check that account now for the confirmation and activation.

Click the blue button: Confirm your account now. If you do not have HTML mail enabled, you will not see a blue button; rather a text hyperlink will be included in your email, which you should use to activate your account.

Your account is now activated. You are ready to participate in the TweetChat. Go to Step 2: Joining the TweetChat.

Step 2: Joining the TweetChat

Using the TweetChat platform provides several features that make it easier to participate in the event, including:

  • The TweetChat platform automatically adds the #AHRQIX hashtag so you do not have to remember to type it in each of your tweets. This is important because other users will not see your tweets during the event unless you include the hashtag;
  • The TweetChat platform automatically displays all participants tweets in real time, so you do not need to refresh your browser to view the most current content; and
  • The TweetChat platform allows participants to retweet posts and reply to others directly.

Note: TweetChat does require users to authorize access to their Twitter accounts. If you do not wish to authorize access to TweetChat, you can still use your Twitter account to participate in the conversation. Be sure to include the #AHRQIX hashtag in your posts though and refresh your browser frequently.

1. On the date of the TweetChat, go to External Web Site Policy, or launch your browser from the embedded hyperlink.

2. You should see the homepage for TweetChat. In the top search box, type #AHRQIX and click the black Go button. You should see the TweetChat window shown above. Click the black Sign In button to join.

3. You will see the following window asking you to allow TweetChat to authorize use of your Twitter account. If you would like to grant TweetChat authorization, choose Authorize app by clicking the blue button.

You have completed the process and are ready to participate. The following window will open and you are now able to participate in the TweetChat. If you have a question or comment, type it in the window provided and click the update button.  You will be able to view all of the participants' questions and comments throughout the event.