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Dr. Coco Auerswald helps homeless youth find their footing

For Berkeley Public Health professor Colette “Coco” Auerswald, working with unhoused youth during the COVID-19 pandemic echoed her early-career experience working with at-risk LGBTQI (lesbian, gay, bisexual, transgender, queer or those questioning their gender identity or sexual orientation), and intersex youth during the 1980s AIDS epidemic in San Francisco.

“In medical school, I took care of many HIV-positive young men at San Francisco General Hospital who were dying of AIDS,” says Auerswald. “It definitively shaped my career. I was already committed to going into adolescent health at that point, and I became obsessed with how to address HIV among youth—specifically youth experiencing homelessness who were disproportionately gay and trans, and who were also disproportionately likely to be using injection drugs.”

Auerswald is now professor of Community Health Sciences in the School of Public Health at UC Berkeley. She also directs the MS Program in the UC Berkeley-UCSF Joint Medical Program and is a pediatrician with over 20 years’ experience in the clinical care of marginalized youth. Along with Berkeley Public Health faculty Emily Ozer, PhD and Ndola Prata, MD, MSc, she co-directs Innovations for Youth (i4Y), a coalition of Berkeley Public Health scholars working to solve the health problems young people face.

The COVID-19 pandemic has hit at-risk young people particularly hard. The California Coalition of Youth surveyed 312 unhoused youth between the ages of 15 and 25 in 2020 and reported that, “In the absence of critical supports, such as housing, education and employment, mental and physical health services and family support, young people are at high risk for increased susceptibility to, and enhanced risk of, unintentional transmission of COVID-19.”

Auerswald and student collaborators created the Ending Youth Homelessness Catalyst Group in 2017. The group quickly pivoted to address the needs of marginalized youth with the onset of the pandemic. Consisting of Berkeley Public Health undergraduate and graduate students, some formerly unhoused, the workgroup combines “ lived experiences of homelessness with research strategies and a passion for advocacy.” Its goal: eliminating youth homelessness among UC Berkeley students and in the Bay Area.

In May 2020, the group released a report “On the COVID-19 Front Line and Hurting: Addressing the Needs of Providers for Youth Experiencing Homelessness in Berkeley and Alameda County.” The report outlined basic needs for youth experiencing homelessness: sanitary public restrooms that are open 24-7, easy access to masks, packaged food, phones, computers, and electricity and Wi-Fi.

Auerswald, i4Y and the UC Berkeley School of Public Health COVID-19 Community Action Team (CAT) also authored a series of recommendations for the San Francisco Board of Supervisors aimed at people experiencing homelessness in the city during the pandemic. Recommendations included providing hotel rooms and/or shelters with bathrooms, sinks, and hand sanitizing stations, as well as masks.

CAT also released a critical report, “For the Good of Us All: Addressing the Needs of Our Unhoused Neighbors During the COVID-19 Pandemic.” The report release was accompanied by a Zoom press conference, and provided recommendations for housing, COVID-19 testing, and sanitation.

Since then, the City of San Francisco teamed with Larkin Street Youth Services to create a temporary Shelter-in-Place (SiP) hotel available for up to 55 young people aged 18-30 who are at higher risk for COVID-19 due to homelessness and being medically vulnerable to the virus; other hotel rooms have also been opened up as part of Project Roomkey. In December 2020, the board of supervisors extended the city’s hotel room program an additional 60 days during a COVID spike. Although youth make up one-fifth of the city’s homeless, the SIP bed program represented just 1/35 of beds available. It has since been closed, but a new youth navigation center has opened in the city.

According to Auerswald, COVID-19 has exacerbated homelessness among youth by increasing poverty, stress, family dysfunction, and the likelihood that young people will have to leave an unsafe or severely neglectful situation.

“It has been harder for youth to stay in school or keep jobs once the pandemic hit,” says Auerswald. “Youth who are marginalized because of race or ethnicity, immigration status, gender identity, or sexual orientation, or who have multiple marginalized identities, are going to be more likely to experience negative consequences to their housing, income, social networks, and stability from COVID-19.”

According to Auerswald, LGBTQI youth are more likely to find themselves unhoused in general due to structural homophobia and transphobia, which can impact their educational milestones as well as their access to stable housing and employment. “Homelessness among trans youth is so common that trans youth generally assume their peers have been homeless at some point in their lives,” she says.

Rejection at the familial level is also common. “Many LGBTQI youth have been kicked out of their homes by their family, and, if they have also been rejected by their extended family or by their communities, may have fewer places to turn than youth who are kicked out due to family dysfunction not related to gender or sexual identity.”

Solutions to LGBTQI youth homelessness include population-specific resources such as earmarked beds in shelters. “The LGBTQ community is very strong, especially in large cities, and in blue states,” says Auerswald. “However, outside of those areas, there are few services specific to youth, and certainly specific to LGBTQ youth. Alameda County, not exactly an isolated rural county, has very few beds overall for the county for youth experiencing homelessness and none that I know of that are specific to LGBTQI youth.”

Greg Ritzinger, a 29-year-old Regents’ and Chancellor’s Scholar of political science at UC Berkeley who identifies as a gay man, aspires to be an attorney, and currently works with Auerswald, serves on her Youth and Allies Against Homelessness (YAAH) team through the Undergraduate Research Apprentice Program.

Ritzinger’s struggles with drug addiction and homelessness began in high school. ”I was a great student, but was eventually kicked out (of school) for smoking pot. The main circumstances that led up to my being unhoused on every occasion revolved around substance use and the criminal legal system.” After circling in and out of jail and rehab, and living in his car and on the streets of San Francisco on and off for a couple of years, he was accepted to UC Berkeley.

Of YAAH, he says, “I am so thankful to be currently involved as now I can try and utilize what I learned through my experiences to inform on projects and try to help others. A huge part of our lab is the involvement of people with lived experience. We have interns on our project that have faced housing issues as well. (Auerswald) really promotes a participatory research model in which the stakeholders are the decision-makers.”

Auerswald says there is a need for community and societal acceptance and financial and emotional support for at-risk youth, who lack resources their peers may take for granted.

“The resources that are needed to prevent homelessness in this population are in two buckets. One is the bucket of resources that all youth need to be able to grow up to be independent adults who are able to work, love, connect to others, and be healthy: a safe, stable home; financial support until they can get on their feet; education or vocational training so that they can earn a living wage and be part of the local economy; and access to Wi-Fi, a cell phone, and transportation so they can function in the 21st century world.

“The second is an accepting community, certainly an adult anchor who will be unconditionally accountable to them, but also a community of peers and adults who accept them and support them.”

Says Auerswald, “Sound familiar? It is what we all need to grow up. We also need to be sure that we do not criminalize youth or put additional obstacles in their way as they try to exit homelessness.”