Miami Herald - Monday, October 28, 2002
Gwen Wurm

You have lived in foster care most of your life. You have failed school. You have been sexually abused. Now the Department of Children & Families, which took responsibility for your welfare, cannot find you. It labels you a "runaway" and does not even consider you "endangered." In fact, it would just as soon you hurry up and turn 18 and become someone else's problem. And assuming you do not die, you will. You will become the problem of the criminal-justice system, the public defender, the family next door and the shopkeeper down the street.

There are more than 325 foster-care children missing in Florida who are labeled as "runaways"; 174 since Aug. 26 alone. Runaway teens, also known as street youth, are at high risk for many diseases and early death. They have about 10 times the risk of being HIV positive as the rest of the adolescent population. With limited access to healthcare services, they often don't get the medications that can keep them healthy. They live on the streets, spread HIV through risky sexual behaviors and get sick.

'SURVIVAL SEX'

Street youths have large numbers of sexual partners, some more than 100. Their condom use is limited. A great many of them are having "survival sex," meaning sex for money, food or to support a drug habit. This is 20-to-50 times higher than teens living at home.

Street youths often turn to substances, in many instances to dull the pain of their circumstances. One study showed that more than 75 percent drank alcohol and about 40 percent had used crack cocaine.

This adds up to increased risk of sexually transmitted diseases, pregnancy, illnesses caused by sharing needles, suicide and homicide as well as a range of mental-health disorders.

And these children are not considered "endangered."

Who is responsible for these teens? Many people say that it's their parents' fault. Why blame the state? But solving the problem means getting past blaming someone. If these parents could control their children, they would, but many of the parents have been victimized themselves. We must commit to finding solutions.

A mouthing-off, disrespectful teenager does not generate a lot of sympathy. But turn the clock back a few years, and you'll find a withdrawn child unable to read in the third grade. Or a 1-year-old crying, with no one to pick her up. These children did not start life as problematic teens. To help them, we must address short-term solutions for the runaways who currently are homeless, and long-term solutions to prevent teenagers from running away in the first place.

Providing special health services and shelters for teen runaways would enhance the lives of adolescents already on the streets.

Teenagers in shelters are less likely to use substances, often because of the "house rules." Drop-in clinics and counseling centers are safe places for teens to get confidential treatment for HIV, reproductive services, substance abuse and mental-health treatment. There are models nationwide that have been successful in attracting street youths and which Florida can emulate.

For prevention, it is imperative that the DCF makes available the records of the missing "runaways." Confidentiality can be kept intact. Sadly, the files will reveal children identified in schools or by the courts in need of psychological help that they did not receive. Children who failed as early as the first grade and were given no remedial support. Families riddled with substance abuse for which no treatment has been made available. Reviewing these records is essential to determining where our system is failing and what services are necessary to provide a more-complete safety net.

We will not be able to give these vulnerable 16-year-olds a home, but with the right resources we can teach them how to build homes of their own. There should be no comfort in the term "runaway"; these adolescents should be treated as special and endangered. They are our children. The streets should not be their homes.

Gwen Wurm, MD, is director of community pediatrics at University of Miami/Jackson Childrens Hospital.

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