conversations on the fringe

Researchers at Chapin Hall conducted a study of the SCAN (Support, Connect, and Nurture) program. This program integrates Family Developments Specialist services and assessment of ACEs (Adverse Childhood Events) with health care and behaviors related to social determinants of health. The results are interesting and could have a huge impact on all youth-serving organizations.

What are social determinants?

The Social determinants of health are the economic and social conditions that influence individual and group differences in health status. They are the health-promoting factors found in one’s living and working conditions (such as the distribution of income, wealth, influence, and power), rather than individual risk factors (such as behavioral risk factors or genetics) that influence the risk for a disease, or vulnerability to disease or injury. The distributions of social determinants are often shaped by public policies that reflect prevailing political ideologies of the area.

The World Health Organization says, “This unequal distribution of health-damaging experiences is not in any sense a ‘natural’ phenomenon but is the result of a toxic combination of poor social policies, unfair economic arrangements [where the already well-off and healthy become even richer and the poor who are already more likely to be ill become even poorer], and bad politics.”

What are Adverse Childhood Events?

The Adverse Childhood Experiences Study (ACE Study) is a research study conducted by the U.S. health maintenance organization Kaiser Permanente and the Centers for Disease Control and Prevention. Participants were recruited to the study between 1995 and 1997 and have been in long-term follow up for health outcomes. The study has demonstrated an association of adverse childhood experiences (ACEs) (aka childhood trauma) with health and social problems across the lifespan.

Participants were asked about different types of childhood trauma that had been identified in earlier research literature:

• Physical abuse
• Sexual abuse
• Emotional abuse
• Physical neglect
• Emotional neglect
• Exposure to domestic violence
• Household substance abuse
• Household mental illness
• Parental separation or divorce
• Incarcerated household member

About two-thirds of individuals reported at least one adverse childhood experience; 87% of individuals who reported one ACE reported at least one additional ACE. The number of ACEs was strongly associated with adulthood high-risk health behaviors such as smoking, alcohol and drug abuse, promiscuity, and severe obesity, and correlated with ill-health including depression, heart disease, cancer, chronic lung disease, and shortened lifespan. Compared to an ACE score of zero, having four adverse childhood experiences was associated with a seven-fold (700%) increase in alcoholism, a doubling of risk of being diagnosed with cancer, and a four-fold increase in emphysema; an ACE score above six was associated with a 30-fold (3000%) increase in attempted suicide.

The ACE study’s results suggest that maltreatment and household dysfunction in childhood contribute to health problems decades later. These include chronic diseases—such as heart disease, cancer, stroke, and diabetes—that are the most common causes of death and disability in the United States.

What does this mean for youth-serving organizations?

A potential intervention point is to address resiliency to mitigate the impacts of ACEs. High resiliency moderated the impact of ACEs on self-reported depression, and resiliency was related to lower rates of substance use (tobacco and alcohol), greater satisfaction with weight, healthier eating, more exercise, and greater overall health. Evidence-based programs designed to build resilience following childhood trauma should be integrated into programming, where ever possible, for any youth-serving organization.

For more information on helping your organization become trauma-informed, contact us to discuss our Trauma Stewardship Training. This is perfect training for churches, outreach programs, and other youth-serving organizations.

Sex work, the exchange of sexual services for resources, lives at the intersection of access to resources, bodily autonomy, self-determination, and resilience. For LGBTQ individuals often barred from traditional forms of labor, services, and resources, survival sex can provide support when institutions fail.

One form of sex work, survival sex, is the exchange of sexual services for the most basic resources including shelter, food, safety, medication, and controlled substances. Individuals may trade sex for those resources directly or for money to meet that need, but the defining scope is one of immediacy and need. These periods can be sustained or time-bound and are experienced by individuals of every gender identity, age, ethnic makeup, and immigration status. Keep in mind that survival sex may only be one of many ways that an individual meets their needs LGBTQ folks are disproportionately impacted by the factors which make people more likely to engage in survival economies. In one study, LGBTQ youth were seven times more likely than straight peers to exchange sex for a place to stay.

Discrimination and stigma from formal employment can bar people from access to living-wage jobs and increase rates of poverty. Informal economies such as the sex trade have provided a backbone of community survival for queer and trans folks in the face of systems that often fail them.

Every aspect of survival sex – including buying, selling, and sharing resources – is criminalized in the United States, and youth in particular face the possibility of status crimes for simply living outside of formal systems. LGBTQ communities experience disproportionately higher levels of policing overall, and laws criminalizing the sex trade contribute significantly to that over-policing and incarceration. LGB young women are twice as likely and LGB young men ten times as likely to be incarcerated in juvenile detention for prostitution charges compared to their peers. The transgender community and trans women, in particular, are disproportionately targeted and profiled as sex workers by law enforcement, who often make the assumption that trans women in certain neighborhoods, or simply standing on the sidewalk, must be engaged in the sex trade. This form of over-policing and profiling is so prevalent that it is referred to as “walking while trans”.

Criminalization of the sex trade compromises peoples’ health, safety, and wellbeing. To
avoid policing, individuals may take other risks, such as moving into more isolated spaces, increasing their vulnerability to physical and sexual violence. An arrest and subsequent criminal record could bar access to public housing and benefits, end opportunities for other forms of employment, and incur fines, fees, and court costs. These harms are all layered onto the existing trauma of policing, arrest, and incarceration.

Within systems of capitalism in which many people are precariously housed and employed, survival sex is a grey area. Rather than over-policing and criminalization, sex workers require
low-threshold, comprehensive resources and opportunities. Consistent, long term housing and a living wage job can be a pathway out of sex work for those who wish to stop. For others, harm reduction information and non-judgment can be powerful tools to help keep sex workers safe. Many survival sex workers are meeting basic needs in the face of socially-constructed circumstances. Criminalizing sex work isn’t about cracking down on sex – it’s about compromising a community’s basic survival

TRIGGER WARNING!

Yesterday was International Day to End Violence Against Sex Workers. Rates of violence against those involved in sex work are extremely high. Even locally we see high rates against sex workers from pimps, Johns, and law enforcement. The problem is, often these workers are not believed or taken seriously and are even victim-shamed for engaging in sex work, to begin with. This implies they deserve whatever happens because they “chose” to be a sex worker.

Hundreds of people are working as sex workers in Central Illinois. Street-based sex work, clubs/bars, hotels/motels, internet-based, escort services, massage parlors, truck stops, etc. This data was collected by Jolt Harm Reduction over the last 6 months from their outreach team members while providing outreach services across Central Illinois. This is real data from right here in our hometown. This isn’t information from a faraway land. This is happening in our own backyard.

Gender
86.4% Female
9.1% Male
4.5% Trans (MTF)

Race
77.3% White
13.6% AfAm
9.1% Puerto Rican

Highest Level of Education
54.5% High School
36.4% College/University
9.1% Middle School

Relationship Status
71.4% Single
23.8% In a Relationship
4.8% Divorced

Do You Have Children?
72.7% Yes
27.3% No

Are They Still In Your Care?
82.4% No
17.6% Yes

When Did You Start Sex Work?
50% 18-25
40.9% Under 18
9.1% 25-30

Where Do You Sleep at Night?
45% Rental/Home
20% Relative’s Home
15% Hotel/Motel
15% Street or Public Spaces
5% Friend

Why Do You Work in the Sex Industry?
81.8% It pays the bills
63.6% It supports my drug use
Average Number of Years Worked
8 years

Who Do You Have Sex With?
59.1% Men
31.8% Women
72.7% Both

How Do You Hook Up?
63.6% Online Sites/Apps
45.5% Strip Clubs
45.5% Hotels/Motels
38.7% Street

Paying Partners (24 hours)
78.9% 1-3
21.1% 4-6

Paying Partners (30 days)
28.6% 1-10
14.3% 11-20
14.3% 21-30
14.3% 81-90

Paying Partners (12 months)
42.9% 300+
19% 1-25
9.5% 26-50
9.5% 51-75
9.5% 100-150

If You Have a Pimp/Manager, What Percentage of Profit Do They Take?
40% 50%
30% 25%
27% 75%
2.3% 95%

While Engaged in Sex Work Has Physical Force or a Weapon Ever Used Against You?
77.3% Yes
22.7% No

Average Age of Assault
21.9 years

Number of Perpetrators
41.2% 3+
35.3% 2
17.6% 1

Describe Physical Force Used Against You
“Punched, kicked, pistol wiped”
“Non-consensual, restrained, kicked punched, burnt, raped with objects, spit on, pistol-whipped, gun shoved in the mouth”
“Kicked in the head’
“Punched, shoved, slapped, stabbed”
“Slapped, kicked, thrown down stairs, bitten, gun pulled, knife held to my throat”
“Guns, knives, tied up and held against my will, hit and kicked”
“Raped, being hit, smacked, shoved down, choked or tied down. Gun pulled on me once (non-consensual or fetish related)”
“Raped at knifepoint and drugged and raped”
“Smacking and choked”
“Pistol whipped, locked in a room”
“Held down and threatened with a knife once and the other I was drugged and raped”

Sustained Injury?
80.3% Yes
19.7% No

Sexual Assault/Abuse (Under 12)
95.5% Yes
4.5% No

Sexual Assault/Abuse (Over 12)
90.9% Yes
9.1% No

Physical Assault/Abuse (Under 12)
90.9% Yes
9.1% No

Physical Assault/Abuse (Over 12)
90.5% Yes
9.5% No

Were You Present When Someone Else Was Harmed, Killed, Seriously Injured, Sexually or Physically?
77.3% Yes
22.7% No

If You Reported an Assault/Rape to Law Enforcement How Did They Respond?
54.5% They Victim-Shamed Me and Told Me It Was My Fault
27.3% They Believed Me and Assisted Me
18.2% The Did Not Believe Me and Offered No Assistance
18.2% They Charged Me With a Crime

Do You Have a Mental Health Diagnosis?
80% PTSD
60% Depression
60% Anxiety

Do You Use Drugs or Alcohol?
90.5% Yes
9.5% No

Increase or Decrease in SU After Starting Sex Work?
86.4% Increase
13.6% Stayed the Same

What is/are the Greatest Risks to Sex Work?
“Forgetting about the pain”
“Rape, abuse or death”
“Death”
“Safety”
“Getting an std”
“Fear of being physically hurt or killed”
“Feeling like I have nothing more to offer the world besides sex”
“Bodily harm, STD, Death”
“My life. I was almost killed 3 different times”
“Murdered, STIs, getting pregnant by a john, physically harmed”
“Being arrested, robbed, raped”
“Being abused and disrespected. Fearing death at times”
“I guess getting an STI or being assaulted again”
“Dead”
“Diseases, risk of violence”
“Put me in risky situations/ STI”
“I’m always worried someone will turn out crazy or violent or stalk me”
“Killed and beaten up”
“My life and wellbeing. I expect to die because of a john”
“Getting sick or beat up”

We’d also like to remind everyone that not all sex work is driven pathologically. Many do it because of the earning potential and they enjoy it. Let’s not demonize nor pathologize sex work. Sex work is actual work and provides a needed service for many people. We just think people that do it should be able to do it without risk of harm.

Unaccompanied homeless youth are young people experiencing homelessness who are not in the physical custody of a parent or guardian. 4.2 million youth and young adults experience homelessness each year. The prevalence of youth homelessness is similar in rural, suburban and urban areas.

Homelessness is associated with an 87% likelihood of dropping out of school. At the same time, the highest risk factor for youth homelessness is the lack of a high school diploma or GED. Youth without those basic education credentials are 4.5 times more likely to experience homelessness.

Homelessness among unaccompanied youth is most commonly caused by severe family dysfunction, and exacerbated by poverty.  Family dysfunction includes abuse, conflict, and substance abuse.  Research shows that 20-40% of unaccompanied homeless youth were sexually abused in their homes, while 40-60% were abused physically. Family conflict over sexual orientation and gender identity plays a role in some youth’s homelessness, as an estimated one-third of unaccompanied homeless youth identify as gay, lesbian, bisexual, transgender, or questioning. Research also has found a clear link between parental substance abuse and youth running away from home. Family homelessness also contributes to youth homelessness: a recent study of homeless and formerly homeless youth found that 47% experienced homelessness both with their family, and on their own.

Unaccompanied youth are at a much higher risk for labor and sex trafficking, assault and other forms of victimization than their housed peers. Most unaccompanied youth are unable to access safe housing or shelter, for a combination of reasons, including: being too young to consent for services without a parent; fear of child welfare involvement; and the lack of services overall: more than half of those who seek shelter cannot access it because shelters are full. The risks for unaccompanied youth also extend to many infants and toddlers, as research indicates as many as 20% of homeless youth become pregnant. In fact, unmarried parenting youth have a 200% higher risk of homelessness than youth without children.

MCKINNEY-VENTO DEFINITION OF HOMELESS
42 U.S.C. § 11434a(2)
The term “homeless children and youth”—

A. means individuals who lack a fixed, regular, and adequate nighttime residence…; and

B. includes —
i. children and youths who are sharing the housing of other persons due to loss of  housing, economic hardship, or a similar reason; are living in motels, hotels, trailer parks, or camping grounds due to the lack of alternative adequate accommodations; are living in emergency or transitional shelters; or are abandoned in hospitals;
ii. children and youths who have a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings…;
iii. children and youths who are living in cars, parks, public spaces, abandoned buildings, substandard housing, bus or train stations, or similar settings; and
iv. migratory children…who qualify as homeless for the purposes of this subtitle because the children are living in circumstances described in clauses (i) through (iii).

Pursuing unaccompanied youth should be a focal point of youth-focused programs. Programs should aim to keep unaccompanied youth safe, facilitate access to secure permanent housing for them. This is best accomplished with inter-agency collaboration and strategies that recognize the unique developmental needs and strengths of young people.

What is your program/organization doing to address the needs of unaccompanied youth?

Youth experiencing homelessness seem to be drawn to our center. They often congregate there to cool off in the air conditioning, get some cold water and snacks, hygiene supplies, take a sink bath in our bathroom, use the free wifi to look up resources, apply for jobs, communicate with others, and make plans for the day. It’s almost like they use it as a home base.

I also think they come here because we remember their names. That’s important. We learn their stories, their fears, hopes, and hurts. They are seen, and for many, for the first time in a long time.

Tens of thousands of young people experience homelessness each year. On the streets, they face serious dangers. Young people often resort to sex work to make money for food, and many turn to drugs or alcohol as a way to deal with the trauma or abuse they have experienced at home. We also hear these stories first hand.

More than half of homeless youth became homeless for the first time because they were asked to leave home by a parent or caregiver.

On average, the youth became homeless for the first time at age 15.

While on 7% of the total youth population identifies at LGBTQIA+ they account for over 40% of all homeless youth.

The average youth spent nearly two years living on the streets.

Fifty-three percent of youth were unable to access a shelter because it was full.

The types of service needs youth identified focused on meeting basic needs — access and challenges related to safe shelter (55.3%), education (54.6%), and employment (71.3%) — and basic supports like transportation (66.6%), clothing (60.4%), and laundry facilities (54.0%).

While homeless, 78.6% of participants had slept in an emergency shelter or transitional living program.

More than 60% of youth in the study were raped, beaten up, robbed, or otherwise assaulted while homeless; 14.5% of participants had been sexually assaulted or raped; 32.3% had been beaten up; 18.3% had been assaulted with a weapon; 40.5% had been threatened with a weapon; and 40.8% had been robbed.

Almost two-thirds of participants (61.8%) reported symptoms associated with depression and were at risk of experiencing clinical depression. Nearly 72% reported having experienced major trauma, such as physical or sexual abuse or witnessing or being a victim of violence, at some point in their lives.

In the sample group, 41.1% identified as Black or African American, 33.3% as white only, 25.7% as Hispanic or Latino/Latina, 21.7% identified as being two or more races, 3% identified as American Indian or Alaska Native, 0.5% identified as Asian, and 0.2% identified as Native Hawaiian or Pacific Islander.

Fifty-four percent identified as male and 45.6% identified as female.

Nearly 30 % of participants identified as part of a vulnerable population.

At the time of the interview, 14.2% of the participants reported caring for children and 9.0% reported being pregnant.

Only 29.5% of respondents reported that they had the option of returning home.

https://www.acf.hhs.gov/fysb/resource/sop-fact-sheet

We must do better. The systemic abandonment they experience it traumatic. More often than not the most effective first step is creating an environment free of judgment. Next, it’s likely housing, which is complicated if they are minors. One of the easiest ways to address the housing issue is to become a licensed foster caregiver and to let your agency/DCFS know that you want older kids.

A majority of foster caregivers want young children or babies. While we understand that, it’s these teens that rarely find or remain in adequate placement. So, they end up on the streets and age/or age out of the system. This cannot be acceptable to those of us who are called to love.

If you are interested in fostering older youth/teens, reach out to your local foster care agency and just begin exploring the idea. You don’t even have to commit to doing anything, just start looking into what it might look like to house and love an at-risk teen.

September is National Suicide Awareness Month.

The organization I started, Conversations on the Fringe, ran a two-year-long study on the lives of LGBTQIA+ youth in Central Illinois. Each student engaged in face-to-face interviews, submitted written responses to an extensive questionnaire, or completed an online survey. We had over one hundred participants. The questions focused on family acceptance/rejection, coming out, stressors, intersections, trauma/bullying, social alienation/acceptance, substance abuse/mental health issues, suicidality, and faith experiences.

If you’ve ever NOT given a person experiencing homelessness money because you just knew they would buy alcohol or drugs, remember this next time…

On cold nights spent outside, alcohol provides temporary warmth. It is also nerve-wracking to sleep in a shelter and difficult to get a good night’s sleep. Alcohol can help an individual relax so they can sleep. Lack of sleep exacerbates mental health issues.

Withdrawals are worse than you could ever imagine. If someone needs to “get their sick off” so be it. Being in severe withdrawal is what drives people to desperate behaviors.

Meth is a stimulant. If you are sleeping outside, vulnerable to anyone and anything, being able to stay vigilant is necessary for survival. This is especially true if you are a woman, trans, or youth.

Being without a home also usually means not eating on the regular or not eating nutritiously. Cigarettes can act as an appetite suppressant. Smoking cigarettes may give some temporary relief from hunger pains.

Bottom line, stop assuming you know the story that brought this individual to this point in their life. Most of us have never known what it feels like to be so desperate that we would have sex for a warm place to sleep or to steal something to survive, or how life-controlling a substance use disorder is.

A large number of people who have not experienced homelessness want to moralize the decisions of poor people, perhaps to comfort themselves about the injustices of the world. For many, it’s easier to think homeless people are, in part, responsible for their suffering than it is to acknowledge the situational factors.

And when you don’t fully understand a person’s context — what it feels like to be them every day, all the small annoyances and major traumas that define their life — it’s easy to impose abstract, rigid expectations on a person’s behavior.

Next time you encounter someone on the side of the road holding a sign, just give them money. It doesn’t matter is it’s the change in your pocket or a $10 bill. Whatever you can give, please, just do it.

The main message it sends to the individual is “I see you and you matter.” Your money will not likely change their situation but it still matters to the individual just trying to get through the day.