Can Integrated Mobile Health Teams Address Health Disparities for Youth Experiencing Homelessness?

Background and Purpose. Youth experiencing homelessness (YEH) are at a considerable health disadvantage and increased risk of many health problems including serious mental illness. Researchers continually point to the importance of intensive, coordinated and comprehensive services to address their health needs.  One approach, integrated mobile health teams (IMHTs), provides field-based integrated behavioral health services to unserved and underserved youth. Research has yet to examine if IMHTs are effective in addressing health care needs for youth experiencing homelessness. The Risk Amplification and Abatement Model (RAAM) which extends the Risk Amplification Model, posits that contact with positive social supports including positive formal supports, can alleviate risk behaviors associated with homelessness.

This paper attempts to address the gap by examining IMHT provider perspectives on the achievability of addressing behavioral health, physical health and health disparities. Specifically, the study aims to: 1)  assess if IMHTs are successful in addressing the behavioral and physical health needs of YEH, and when effective, what are the strategies that facilitate this approach and when it fails, what are the barriers, from the perspective of providers. 2) identify, how and to what extent, are IMHTs successful in addressing health disparities in YEH, and specifically disparities in regard to race/ethnicity, gender, and sexual minority status.

Methods. Thirty in-depth, semi-structured interviews were conducted with IMHT health and mental health providers (13 social workers, 10 case managers, 2 peer advocates, 3 nurses, 2 psychiatrist) exemplified by a RAAM conceptual framework.  The sample is predominantly female (73% female; 27% male), Latino (46% Latino; 10% Black/African American; 10% White; 5% Asian; 29% Other). Participants were recruited via oral announcement for all IMHT staff at three non-profit behavioral health organization. Interviews were transcribed verbatim and coded thematically using Atlas.ti qualitative software, guided by the principles of grounded theory and an inductive approach to qualitative analysis. 

Results. Data analysis reveals that frontline IMHT providers who experience consistent supervisory and team support, role clarity, job autonomy and shared decision making, perceive fewer barriers to field-based clinical services for YEH.  IMHT physical health providers, nurses and psychiatrists, report initial difficuly with acclimating to field-based integrated health care services and co-located behavioral health workflows.  All IMHT providers identified housing as a barrier to providing field-based clinical services; however, team members with stronger supervisory and team communication, reported increased successes with YEH in referral and linkage to housing. Findings suggest that although IMHT providers identified a need to tailor services to meet the unique needs of racial/ethnic and sexual minority health disparities in field-based integrated health care services, there was limited perspective on the application of culturally tailored services.

Conclusions and Implications. IMHT holds much promise to improve outcomes for unserved and under-served YEH.  Strong supervisory support is critical for IMHT workers to enable them to provide effective linkages and referrals to interventions, particularly housing programs.  Perhaps most striking is the perceived need for but lack of support for culturally tailored services to address the special needs of racial/ethnic and sexual minority youth.