Access to healthcare among youth experiencing homelessness: Perspectives from healthcare and social service providers

Access to healthcare services is critical for youth experiencing homelessness (YEH) given their high risk of experiencing adverse physical and mental health outcomes. Previous studies have identified factors that impact YEH's access to healthcare services from the perspective of YEH, but less is known from the perspective of providers. The purpose of this study was to examine providers' experiences and perceptions of the barriers and facilitators that impact YEH's access to healthcare. Semi-structured interviews were conducted with 17 healthcare and social service providers in Houston, Texas. Drawing on constructs from healthcare access frameworks, findings were categorized into barrier-and facilitator-related themes that reflect five dimensions of healthcare access: approachability, acceptability, accommodation, affordability, and adequacy. The most commonly reported barrier was the high-barrier healthcare service delivery system (e.g., numerous documentation requirements, multi-step process) that YEH had to navigate in order to access healthcare services, followed by the limited availability of free and low-cost healthcare services. The most commonly reported facilitator was building interagency relationships that helped streamline the referral process and provided direct organizational contacts that could be called upon when YEH need assistance. This was followed by offering healthcare navigation assistance (e.g., teaching YEH how to identify healthcare services online) and accompanying YEH to appointments, which better ensured YEH's access to care. Collectively, study findings indicate that the complex way in which healthcare services are currently organized and delivered fails to adequately accommodate YEH, who need low-threshold access to youth-centered healthcare services. Gaps in YEH's access to healthcare services can be narrowed using a combination of administrative strategies and research efforts. These include implementing policies, programs, and practices that incorporate trauma-informed principles in YEH-serving organizations; establishing interagency collaborations to better facilitate the service connection process; and developing and evaluating patient navigator programs designed to increase YEH's access to healthcare services.