Last fall, 3-year-old Jazzy came to my clinic at St. John’s Well Child and Family Center in South Los Angeles because she couldn’t breathe. Jazzy, whose name has been changed, was with her parents and little brother.
“She has asthma and the nebulizer machine helps,” said her mother, who told me that they couldn’t give her the treatment because they didn’t have electricity.
I assured her we could fix that—there are programs to keep power in the house for medical needs.
Then Jazzy’s dad said, “Well, Doc, it’s a little bit more serious than that.”
The family was homeless and living in their car.
Jazzy’s story isn’t unique. I often say this about my patients. Working in South LA, I see a lot of children living on the fringes and whom, at times, society wishes they could forget. Many of the kids are poor, hungry, mistreated, immigrants and minorities (in race, ethnicity or sexual identity). Like Jazzy, some are also homeless.
But these children are part of our community and they need us to look out for them. I tell their stories hoping that they won’t be forgotten.
In Los Angeles County, more than 10,700 youth, ages 24 and younger, are without a stable home. Three-quarters of them are Latino or African American. About half are alone, living without an adult caregiver. Nearly all of them wish for a safe, stable home.
In California, the number of homeless youth has increased by 20 percent since 2014. Across the state, more than 200,000 students, in kindergarten through 12th grade, don’t have a roof over their heads. The actual number is hard to know but it’s likely higher. One reason: Some parents are embarrassed to disclose homelessness. Also, children who live in motels or “couch surf,” meaning they stay temporarily with friends or family, aren’t always counted in the statistics.
Youth become homeless for many reasons. The most common is poverty—the lack of affordable housing and low wages are major factors. Some adult caregivers aren’t able to maintain housing due to mental illness, substance abuse, unemployment or because they are fleeing domestic violence. Some children and teens run away from home to escape abuse. And as I reported previously, some LGBTQ youth become homeless because they are kicked out of the house because of their sexual identity.
Homelessness is a threat to health and wellbeing for any age. However, for children and adolescents the effects may be intensified because their bodies and brains are still developing. Researchers have shown that incurring adverse childhood experiences contributes to a lifetime of poor health and even early death.
Children without a place to live have higher rates of physical and mental illness, compared to low-income peers with stable homes. The kids are more likely to experience hunger, malnutrition, frequent infections, dental cavities and chronic illnesses such as asthma. They have high rates of mental disorders including anxiety and depression, and are more likely to commit suicide than children with stable homes.
Homeless children have more developmental delays and missed school days. They frequently change schools, and they have lower graduation rates. In one study of adolescents in an emergency shelter, only a third attained a high school diploma or general equivalency diploma by age 18.
Often homeless encampments are in urban or blighted areas causing children who live there to be exposed to environmental toxins, air pollution, human waste and vermin. Without shelter or emergency supplies, they are also extremely vulnerable to natural disasters, such as earthquakes.
While living on the streets, kids can be exposed to unimaginable circumstances, including witnessing or being victims of violence, exploitation, prostitution and illicit drug use.
Despite their extensive needs, homeless children have less access to physical, mental and dental health care.
“It’s really hard for (people who are) homeless to get appropriate care, especially for mental health,” said Jessenia Garcia, associate director of Homeless Services Program at St. John’s, a federally qualified health center. St. John’s has clinics and mobile vans located in some of LA’s poorest neighborhoods. The homeless program provides case management and easier access to medical and mental health care, as well and community outreach. The program works closely with other county and community agencies to help homeless patients find resources.
“We need permanent, safe and supportive housing, “ Garcia said. Affordable housing integrated into accepting neighborhoods, along with nutritious food, are the most important things to help homeless people have better health, she added.
Jazzy is a clear example of what a difference access can make. She was able to go to a clinic in her area. Her asthma symptoms improved promptly with an albuterol breathing treatment. In addition, the Homeless Services Program referred her family to a temporary shelter. These were small—but critical—steps in the right direction for her health.
A little less than a month after her asthma attack, Jazzy returned to the clinic for a recheck. Her asthma was controlled because she was regularly receiving her medications. Although the family was still living in a shelter, the Homeless Services Program continued working with them to find permanent housing.
Fortunately, Los Angeles has passed legislation to combat homelessness, such as the Proposition HHH property tax, which includes funding for housing and health care services.
I hope California continues to take steps to help the thousands of homeless children like Jazzy. Their lives depend on it.
Pediatrician ChrisAnna Mink writes the bimonthly Doctor’s Notes column on children’s health.