Medical Student Icahn School of Medicine at Mount Sinai New York, New York, United States
Background: The crisis of youth and young adult (YA) homelessness continues throughout the US, with non-White young adults significantly more likely than White peers to be unstably housed. Racism, marginalization and poverty impact these individuals’ overall health and their access to care, quality of care, and experiences of care. Objective: This study’s objectives are to elucidate how YAs who have experienced homelessness perceive their interactions with healthcare and explore how their accounts of adversity within the healthcare system compare with those of the clinicians and community members who care for them. Design/Methods: We conducted in-depth semi-structured interviews with 9 homeless YAs of color and 10 other key informants (clinicians, policy makers, social workers, and public health advocates) to explore the impact of homelessness as a stigma-conferring identity and how racism and homelessness shape young peoples’ interactions with a variety of actors in an inner-city healthcare system. Interviews were recorded, transcribed, and analyzed using a modified grounded theory approach to categorize data into themes using MAXQDA qualitative software. Results: The YAs interviewed were aged 19-22 years, 7 were Black, 2 Latine; 5 female and 4 male. Key themes from YAs included: (1) perceiving homelessness to be a salient identity; (2) concealing homelessness to avoid stigma in medical encounters and facing consequences if efforts failed; (3) describing homelessness as a stigmatized identity that mediates access, quality and outcomes of healthcare, but viewing racism as having a lesser impact. Key themes from health professionals included: (1) Black and Latine YAs often receive lower quality care because of systemic racism; (2) YAs experience interpersonal racism within health encounters; (3) racism limits YAs’ agency and ability to advocate for themselves.
Conclusion(s): Black/Latine YAs interviewed view homelessness as the mediating factor in access to care, experiences of care, and health outcomes. Those who care for them attribute challenges with care to racism and poverty, but the youth rejected the impact of racism and focused on homelessness as a profoundly stigmatizing identity that led to problems in receiving quality healthcare. To address the intersecting stigma and racism experienced by YAs experiencing homelessness, we suggest providing additional training for clinicians in structural competency, giving vulnerable youth access to patient advocates, and creating robust multi-disciplinary team-based care with co-located social services.
.jpg "Rachel G. Kasdin, M.S. (she/her/hers) photo")