Voices from the Field Blog: The Human Connection

by Darby Penney
February 17, 2015

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Homeless and Housing Resource Network Contributing Writer Darby Penney writes about New York City’s Hetrick-Martin Institute (HMI) which has focused for more than 35 years on meeting the needs of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. Through human connection and cultural activities, HMI makes a difference in the lives of young people, many of whom became homeless after being rejected by their families of origin.

At 3:15 pm every weekday, Annalee Fannan opens the pantry at New York City’s Hetrick-Martin Institute (HMI), and offers up donated clothing, toiletries, and snacks to the lesbian, gay, bisexual, transgender, and questioning (LGBTQ) young people who participate in HMI’s lifesaving services and programs. About 80 percent of these youth are experiencing homelessness or marginally housed, and they can take advantage of the pantry’s showers and laundry facilities, too, and stay for a hot meal at dinnertime. Fannan, the pantry coordinator for HMI’s Homeless Youth Services, gets to know members’ tastes and sense of style, and may put aside certain clothing that matches their personalities, like high-end stylish shoes and gloves. This human connection, as well as the material assistance, makes a difference in the often chaotic lives of the young people, many of whom became homeless after being rejected by their families of origin when they came out as LGBTQ. Others aged out of foster care or ran away from situations where they felt unsafe, only to end up on the streets, with a different set of urgent safety concerns.

“While it’s hard to get an accurate count, some agencies estimate that there are between 3,000 and 5,000 unsheltered youth between the ages of 12 and 24 in New York City annually,” said Fannan. “Yet there are only 250 beds in youth shelters across the city. There are a few emergency housing programs specifically for LGBTQ youth, like those offered by the Ali Forney Center, where people can stay for up to 30 days, and there are some transitional living programs, where people can stay for a year. But these resources aren’t nearly enough. And LGBTQ youth may have difficulties at shelters that do not understand their specific needs and problems. The youth we serve have limited options: many are couch-surfing, staying sporadically with friends, or sleeping on trains. We know of youth who have gotten married or gotten pregnant in hopes of finding better housing. Others use survival sex to find a place to stay, whether for the night or longer.”

While the situation in New York City is critical, the extent of homelessness among youth across the nation—particularly LGBTQ youth—is alarming. There are between 1.6 and 2.8 million young people experiencing homelessness in the United States, according to a report by the Center for American Progress, and a disproportionate number of these identify as LGBTQ: about 40 percent, compared to a rate of 5-10 percent among the general population (Quintana, Rosenthal, & Krehely, 2010). These young people tend to become homeless at very young ages: on average, gay and lesbian youth become homeless in New York City at 14.4 years of age, and transgender youth at 13.5 years. A 2012 national study of services provided to LGBTQ youth experiencing homelessness confirmed these statistics (Durso & Gates, 2012). In addition, 43 percent of youth surveyed said they became homeless when their parents forced them out of the home because of their sexual orientation or gender identity; 32 percent reported being physically, emotionally, and/or sexually abused at home.

It is not surprising, then, that LGBTQ youth experiencing homelessness have very high rates of mental health and substance use problems, violent victimization, suicidal acts, and engage in a range of HIV risk behaviors (Keuroghlian, Shtasel, & Bassuk, 2014). It is important to note that LGBTQ youth are not a homogenous population, and different subgroups have varying needs that must be understood and addressed. As Keuroghian and colleagues (2014) point out, there is a public policy vacuum when it comes to this population: “…an explicitly articulated federal health policy agenda does not yet exist to address homelessness among LGBT youth in the United States.” The Center for American Progress recommends, as a start, that discrimination against these youth should be overtly banned in all federal programs and agencies (Quintana et al., 2010).

Hetrick-Martin Institute is the nation’s oldest and largest LGBTQ youth-serving organization, and has focused for more than 35 years on meeting the needs of at-risk LGBTQ youth in New York City and beyond. For example, HMI’s newest initiative, the Center for LGBTQ Youth Advocacy and Capacity Building, advocates on behalf of LGBTQ youth by influencing policy on local, national, and international levels, while helping to build the capacity of decision-makers, individuals, and institutions that serve this marginalized population. HMI is also the founder and host agency for the Harvey Milk High School, a small, fully accredited public high school run by the New York City Department of Education for at-risk LGBTQ students who were unable to safely complete their education in traditional public high schools. HMI’s Homeless Youth Services offers a comprehensive set of direct services and referrals for youth aged 13 to 24 in an LGBTQ-friendly environment. While HMI does not provide housing, it refers youth to emergency, transitional, and permanent housing providers, and offers an array of supports. The Health and Housing staff, for example, do street outreach at the parks, piers, and other places where LGBTQ youth experiencing homelessness gravitate, working to develop trusting relationships with young people to encourage them to use HMI services.

These services include an after-school program that offers arts and cultural activities, such as dance, film, photography, painting, and theater, which are very popular with members. Tryouts for a production of West Side Story were scheduled the day Fannan and I spoke, and HMI regularly hosts vogueing and ballroom events, which serve as both an outreach tool and entertainment. In addition, HMI’s after-school program (which is open to youth whether or not they are attending school), offers health and human services such as mental health and substance abuse counseling, HIV testing, job readiness and career exploration, and housing referral.

Housing and homeless service providers need training on cultural competency that is specific to LGBTQ youth, Fannan believes. Too many providers— including foster care agencies, housing providers, and behavioral health organizations—are not familiar with the varieties of LGBTQ youth cultures, and this can interfere with serving these young people appropriately. “Providers need to meet these youth where they are,” Fannan said. “There’s a need for more harm reduction programs and staff who understand the lives of these young people.”


Durso, L.E., & Gates, G.J. (2012). Serving our youth: Findings from a national survey of service providers working with lesbian, gay, bisexual, and transgender youth who are homeless or at risk of becoming homeless. Los Angeles: The Williams Institute with True Colors Fund and The Palette Fund.

Keuroghlian, A. S., Shtasel, D., & Bassuk, E. L. (2014). Out on the street: A public health and policy agenda for lesbian, gay, bisexual, and transgender youth who are homeless. American Journal of Orthopsychiatry, 84(1), 66.

Quintana, N.S., Rosenthal, J., & Krehely, J. (2010). On the streets: The federal response to gay and transgendered homeless youth. Washington, D.C.: Center for American Progress. Available at: https://cdn.americanprogress.org/wp-content/uploads/issues/2010/06/pdf/lgbtyouthhomelessness.pdf

For more information about Hetrick-Martin Institute, visit http://www.hmi.org/

Interested in being an HRC Guest Blogger? Email us at HomelessPrograms@samhsa.hhs.gov.

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Rachel's Story

by Wayne Centrone
June 22, 2011

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Sometimes the most important lessons—the kinds of lessons that have lasting effect on one’s attitude or outlook—occur in the most unlikely of situations. I recently recalled a patient I had the good fortune of working with a number of years ago, while I was still in clinical practice.

I had a busy morning in clinic that day. The schedule did not leave a spare moment for reflection. After a working lunch, I planned to catch up on phone calls and e-mail correspondence. Around 2 p.m., a young woman came to the clinic. She really made me think twice about all the “business” in my life.

Rachel (not her real name) was a 16-year old suffering from a heroin addiction. She wanted help with her third attempt at drug detoxification. What made Rachel so unique to me (keep in mind that I worked for a number of years in very close proximity to a needle exchange program and thus saw many intravenous drug use patients) was the fact that she came to the clinic with her parents. Mr. and Mrs. Smith (again, not their real names) were anything but “typical” patrons at my clinic. They were both in professional careers, lived an upper-middle class lifestyle, and never thought they would find themselves sitting in a community healthcare center. However, they expressed their commitment to Rachel and wanted to help in any way possible.

It is important to mention that injection drug users do not fit a particular profile. Sure, we can stereotype them to the “skid row” image of Hollywood, but there really is no “one size fits all” addict. I saw injection drug users come into the clinic fresh off the streets, and I saw some come straight from their offices. The single caveat that holds them all together is their powerlessness over a drug that has the potential to destroy their lives.

Rachel started using drugs when she was a 13-year old. She never saw herself becoming an addict. It just seemed to happen. Previous attempts at detox and sobriety had all come to naught. Strung out as a 16-year old, her face held the sort of sorrow that one would expect to see on someone many years her senior. Rachel was the victim of a life that she never envisioned nor desired. She was angry and scared. Most of all, she needed help.

I now know that one does not need to be a great thinker or renowned scientist to make a difference in the world. Rachel did not need a marvel of modern medicine. She did not want someone to lecture her about the “deleterious” effects of injection drug use. She really only wanted to get well.

Acute early detox-related treatment for injection drug use is not standardized. Earlier that day, Rachel and her family tried to see their family doctor. That doctor told them not to come, because she would not treat Rachel. They tried going to a doctor recommended by a friend, but again the services they requested were not available. Finally, in desperation, Mrs. Smith phoned the needle exchange program at our clinic. She heard that we had limited resources. She said she wanted to come in anyway.

What Rachel and her family needed was someone who would listen to their concerns, and show them that they were not alone. What they wanted from me was a listening ear and a concerned advocate.

What I learned from this remarkably strong family was that I make a difference just by being present to the suffering of another person. I learned that the “little things” (a smile, the gentle touch of a caring hand, an open heart) comfort the biggest of worries and sorrows. I learned that taking time to care about another means that I need to be present to suffering. Most of all, I learned that life’s most significant lessons come in the most unlikely of ways.

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