Mental Health
Designing Mental Health Treatment for Homeless Youth
 J was living on the streets after running away from an unstable and abusive home. The 17-year-old struggled with depression, regularly used speed and had dropped out of school. But with the aid of comprehensive mental health services from Larkin Street Youth Services in San Francisco, including case management, substance abuse counseling and individual therapy, he was able to get clean, pass his high school equivalency exam, and obtain stable housing and a part-time job.
 Since 1984, Larkin Street has been helping homeless youth like RJ with support and resources to develop the skills necessary to move beyond street life for good. In March 2004, TCWF awarded Larkin Street a three-year, $150,000 grant to sustain and expand its Assertive Community Treatment (ACT) initiative to provide mental health services to homeless and runaway youth in San Francisco.
According to Clinical Director Eliza Gibson, most youth served by Larkin Street have histories of abuse and trauma. Many suffer from depression, post-traumatic stress disorder and substance abuse. Many youth frequently have been or become suicidal. The possibility of abuse and trauma on the streets, as well as coping with the ongoing uncertainty of homelessness, frequently exacerbates existing mental health and substance abuse problems and can create new ones.
In response to these recurring issues, Larkin Street created the ACT initiative in 2001. Integrating a mental health, clinical framework into its established service-based system, the program’s goal is to make mental health services more accessible and available to youth who would not otherwise access services in the community.
The ACT initiative provides individual and group counseling services, psychiatric assessment, multidisciplinary case management and referrals to community-based, long-term mental health treatment centers. Larkin Street’s consulting psychiatrist provides training to staff, conducts psychiatric evaluations and offers brief therapy to clients.
With its grant from TCWF, Larkin Street has been able to sustain its provision of comprehensive mental health assessments as well as ongoing counseling services with mental health specialists.
“Assessments allow counselors and case managers to identify early when a youth is in need of mental health services,” said Gibson. “Ongoing counseling is essential to support homeless youth, help them learn more effective coping skills, and realize they have options and great potential to live independent, stable lives.”
Larkin Street has integrated four MSW case management interns into the program and their presence has contributed significantly to the learning and training environment, said Gibson. Additionally, Larkin Street has pursued collaboration with other city providers, particularly with the city’s and county’s transitional youth and child crisis services, allowing the organization to provide coordinated and nonduplicative care to clients like RJ.
The ACT initiative has also increased the agency’s understanding of the profound connection between mental health and substance abuse. To address the service gap that keeps dually diagnosed youth from succeeding in its programs, Larkin Street has explored new ways to integrate its mental health and substance abuse services to better assess and address the clinical needs of this population. This work includes building its clinical capacity to have specialists who are cross-trained in mental health and substance abuse.
“The mental health needs of California’s homeless youth are significant,” said Jeffrey Kim, TCWF program director. “The integrated mental health services of Larkin Street Youth Services provide an essential safety net to ensure the health and wellness of this vulnerable population of youth transitioning to adulthood.”
For more information, please visit www.larkinstreetyouth.org.
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