LGBTQ youth and young adults living in one of the most medically-underserved cities in the state of Michigan will now have access to mental health, substance use disorder treatment and prevention, and primary healthcare. The Ruth Ellis Center, which incorporated as a youth social services agency seventeen years ago, will open the Ruth Ellis Health and Wellness Center to expand their services this year. REC will continue to provide short- and long-term residential safe space and support services for runaway, homeless, and at-risk LGBTQ youth in Highland Park and Detroit. By adding integrated behavioral and primary healthcare services, REC will take a critical step forward to meet the ever-changing needs of the young people they serve.
“While this may feel like new territory for some, we see this more as an evolution than a revolution in services for LGBTQ youth,” said REC Executive Director Jerry Peterson, who shared REC’s passion with Henry Ford Health System CEO Nancy Schlichting in the fall of 2013.
After careful consideration, and input from the Henry Ford Department of Pediatrics, Schlichting generously offered the in-kind support of Henry Ford to help guide the planning of this project. The design was developed and approved in collaboration with William Mazzara, Director of Facilities, Design and Construction and Christie Wilkewitz, Group Practice Operations Director of Henry Ford’s School-Based and Community Health Program.
“Both Henry Ford Health System and the Ruth Ellis Center are deeply committed to improving the overall health of the communities we serve,” Schlichting said. “Many young LGBTQ individuals experience significant barriers to accessing even the most basic healthcare services.” These barriers include geographical disbursement, an inadequate transportation system, prejudice among healthcare providers, as well as the need to maintain anonymity to guard personal safety. “The Ruth Ellis Health and Wellness Center will play a critical role in making high-quality primary and behavioral health services more accessible to the LGBTQ community,” Schlichting said.
HWC Construction Underway
More than a year after intense internal planning came to a close, REC launched its first capital campaign in April 2015. Through the generosity of individuals and a few foundations, REC was able to reach 60 percent of their $1.5 million goal. This made it possible to break ground in December. Since then, REC has raised an additional 15 percent. While construction of the 5,000-square-foot space at their Highland Park facility is well underway, REC leadership will continue to work with individuals, corporations and foundations to secure the remaining funds needed to complete the campaign.
“The amount of enthusiasm, compassion, and generosity we have received throughout this campaign has been overwhelming,” REC’s Director of Development Mark Erwin-McCormick said. “This isn’t about a renovation or expansion; this is redefining how we make healthcare accessible to some of the most vulnerable among us, and that, people want to invest in.”
Building Health Literacy, Cultural Competency
As of June 2016, 817 unique individuals who call Highland Park or Detroit their place of residence access REC services with varying rates of intensity and duration. Around 500 youth and young adults access services annually, of which ten percent are ages 13-17, 80 percent are ages 18-24, and ten percent are ages 24-30. Of them, 40 percent are living with HIV. The HWC works in close collaboration with service providers in the city of Detroit who offer HIV treatment and care. REC staff members visited some local clinics to study successful services and sustainable practices in operation. Many of those clinics are located inside traditional healthcare spaces that are not emotionally accessible to LGBTQ youth.
“We will work with these individuals to understand what to expect if you go to see your HIV provider. We’ll talk about what they’re going to be doing in terms of labs and really build that health literacy that makes those spaces more comfortable,” Henry Ford Pediatrician Maureen Connolly, M.D said.
The HWC will provide HIV testing, guidance and prevention services, but is not to be confused with an HIV clinic.
“A lot of specific health care needs cannot be addressed in a primary care space, so part of the goal is to build strong relationships with other providers in the city with this accessible space as a starting point,” Connolly said. That includes cultural competency training for front office and intake staff that Peterson said need to be more receiving and affirming of LGBTQ youth who are referred to them for help.
REC currently operates four core services – a residential housing program known as Ruth’s House, the Second Stories Drop-In Center, Second Stories Outpatient Mental Health Services, and the Family Preservation Program, an innovative two-year pilot with significant state-wide implications.
“We are not transforming REC into something we’ve never been. This is establishing a new and expanded array of services that our young people need, specifically tailored to them,” Peterson said. When deciding what cost-free services to provide, he said, “Our number one guide is always going to be what do the unstably-housed, LGBTQ youth of color in Highland Park and Detroit need.” To find out, the HWC did what it has done for seventeen years – ask the youth themselves.
LGBTQ Youth Want to Be Healthy
Beyond sore throats, ear infections, asthma management and diabetes, most LGBTQ young people are concerned about STD testing and treatment, birth control information and contraceptives, pregnancy testing and prenatal care, and treatment for substance use disorder. Vision and hearing screening tests will be available with referrals as well. Dental services to include cleaning, exams and prevention are on the list of services to provide in the near future.
“So far, there is so much enthusiasm from the youth,” Connolly said. These motivated young people, she said, were already banging on the door of the mobile outreach vehicle that has been in service every Monday since May 2016. REC entered into a formal service agreement with the Henry Ford School-Based Community Health Program and Global Health Initiative for primary care services in the HWC. The mobile clinic has allowed the HWC to introduce the Henry Ford team to young people while the HWC is under construction.
“It is inspiring to see these young people taking ownership over their own health and will hopefully serve as a model for other centers working with LGBTQ youth across the country,” she said.
REC has emerged already as a national innovator in addressing the needs of LGBTQ youth and young adults experiencing homelessness and other barriers to success. In support of that service, the Michigan Health Endowment Fund recently supported REC with a grant totaling $358,750 to support integrated behavioral and primary healthcare services for LGBTQ youth.
REC Connects LGBTQ Children and Families
With Michigan Minor Consent Laws in place, considerable opportunities are available for LGBTQ youth to access care without parental consent. However, Connolly said that “every young person is served best by having as many supportive adults involved as possible. Our intent is never to try and go behind the back of any family member or adult, but it is really a matter of what the young person is most comfortable with and how we are going to get them the services that they feel they need to be healthy.”
Young people ages 14 and older are permitted up to 12 mental health counseling visits without parental consent. Many of which, Connolly said, are geared toward thinking about the adults in their life, if any, and how they can all work together.
“For many LGBTQ youth, mental health counseling provides an opportunity to discuss the process of coming out to family and friends, safety planning and considering our best and worse case scenarios,” Erwin-McCormick said. “A young person’s ability to discuss this incredibly sensitive topic, in a safe and supportive environment, is just one reason these permissions exist.”
Family conflict due to a child’s sexual orientation, gender identity or expression is the leading cause of LGBTQ youth homelessness nationwide. REC’s Family Preservation Program, in partnership with the Michigan Department of Health and Human Services, Child Protective Services, and the Family Acceptance Project conducted by Dr. Caitlin Ryan is the first intervention of its kind tailored to address the disproportionate number of LGBTQ youth experiencing homelessness nationwide. Families who are being investigated by CPS or are at risk of their child being placed in the children’s welfare system, are referred to REC for up to 13 months of intense family services. As part of the pilot, REC has trained more than 400 CPS investigators to effectively identify, and advocate for LGBTQ children whose families are conflicted over their sexual orientation, gender identity or expression.
“Historically, organizations have demonized families for rejecting their children due to their sexual orientation, gender identity or expression,” Erwin-McCormick said about the program that helps families recognize rejecting behaviors in the home and the devastating affect they have on their LGBTQ children.
Needs of Transgender Youth Addressed
Nearly 20 percent of the youth who access services at REC identify as transgender, and many seek transition care specifically, but hormone therapy requires the consent of an adult for minors. Connolly ensures there are medical interventions the HWC can offer to help these young people feel more comfortable and affirmed in their gender identity until then. The Family Preservation Program is also uniquely tailored to work with families struggling to understand their child’s desire to transition.
“Once over the age of 18, we go through an informed consent process with them and if transitioning has been identified by the young person as the appropriate next step, that’s what we provide. Supporting them as they become the most authentic version of themselves is exciting and a pretty new area of medicine,” she said.
REC Community Outreach
“A group of individuals, some who identified as LGBTQ, others, straight allies, came together one summer weekend nearly two decades ago to brainstorm ways they could support the growing number of LGBTQ youth experiencing homelessness in their community,” Peterson said.
Their answer was the REC, named after one of Detroit’s oldest and most beloved lesbian activists. Ellis opened her home on the east side of Detroit as early as the 1930’s as a safe place for the LGBTQ community.
Peterson continued, “It was their thought that no young person should ever be denied the safety and support they deserve, just because of who they were. And now, seventeen years later, after achieving a historic victory in marriage equality, I pose this question…will you join this group of individuals? Will you invest in the health and wellbeing of hundreds of deserving LGBTQ youth so that they may enjoy the same progress we have?”