Rights of Youth and Young Adults in Residential Programs: Report to the Legislature, January 2020

Summary

Rights of Youth and Young Adults in Residential Programs, a January 2020 report to the Legislature from the Washington State Department of Commerce's Office of Homeless Youth Prevention and Protection, prepared pursuant to Chapter 415, Laws of 2019. It responds to a 2019-2021 operating budget proviso directing the office to recommend rights for unaccompanied homeless youth and young adults in residential programs. The report describes co-design sessions with The Mockingbird Society Tacoma Chapter and the Youth for Youth board and reviews OHY grant agreement requirements and other practices. It recommends a standard set of rights in OHY contracts, co-development of additional rights with youth participants, and outreach and educational tools. The closing pages set out recommended rights including privacy, grievance and youth choice in service planning.

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Full text

Rights of Youth
and Young Adults
in Residential Programs



Pursuant to Chapter 415, Laws of 2019 (Section 129 (31))




                                          January 2020

                                          REPORT TO THE LEGISLATURE

                                          Lisa Brown, Director
Acknowledgments

Thank you to the young people who shared their
expertise and helped shape these
recommendations. Specifically, thank you to
The Mockingbird Society, Tacoma Chapter and
the Youth for Youth (Y4Y) board for
participating in co-design sessions for this
project.




Washington State Department of Commerce

Kim Justice, executive director

OFFICE OF HOMELESS YOUTH PREVENTION AND
PROTECTION

1011 Plum St. SE
P.O. Box 42525
Olympia, WA 98504-2525

www.commerce.wa.gov
For people with disabilities, this report is available
on request in other formats. To submit a request,
please call 360.725.4000 (TTY 360.586.0772)




 RIGHTS OF YOUTH AND YOUNG ADULTS IN RESIDENTIAL PROGRAMS
Table of Contents
Executive Summary........................................................................................................................... 2

Introduction ...................................................................................................................................... 3

What Young People Have to Say ........................................................................................................ 5

State, National and International Practices ........................................................................................ 8

Recommendations .......................................................................................................................... 16




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Executive Summary
Overview
The 2019-2021 operating budget (Section 129(31)) includes proviso language directing the Department
of Commerce’s Office of Homeless Youth (OHY) as follows:

"Within amounts appropriated in this section, the office of homeless youth prevention and protection
must make recommendations to the appropriate committees of the legislature by October 31, 2019,
regarding rights that all unaccompanied homeless youth and young adults should have for appropriate
care and treatment in licensed and unlicensed residential runaway and homeless youth programs."

Key Highlights
   Youth of color and those who identify as LGBTQ+ are at higher risk of experiencing homelessness
   and are at greater risk of harm.

   The OHY currently also requires all grantees to have a "Participant Rights and Responsibilities"
   policy that outlines the rights of young people in care.

   State, national, and international research provide guidance on the treatment of youth and young
   adults. This guidance includes the rights of youth participants, as well as a broader set of protocols
   or standards on how best to serve young people.

   Young people describe examples of poor treatment and negative experiences they have had when
   receiving services and offer up recommendations on rights that could ensure appropriate
   treatment.

Recommendations
The unique needs and vulnerabilities of young people experiencing homelessness calls for more
extensive guidance on their treatment when being served in residential programs. The OHY engaged
young people with lived expertise and researched state, national, and international approaches to
inform its recommendations. The OHY recommends the following:

1. Include a standard set of rights in OHY contracts with all programs serving unaccompanied youth
   and young adults experiencing homelessness (see page 16 for the recommended rights).

2. In addition to the standard, or baseline set of expectations, OHY contracts should require that
   agencies co-develop additional rights and expectations with youth participants. This approach
   ensures that the unique needs of young people in each community are represented while also
   promoting collaboration and a shared understanding of needs among program participants and
   professionals within agencies.

3. Conduct outreach and develop educational tools to improve communication and increase
   compliance with standards. With additional capacity, the OHY could foster continued discussion
   with service providers and young people to ensure that standards are brought to life in practice and
   that tools are in place for OHY to measure compliance.


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Introduction
Approach
The OHY used multiple approaches to gather information to inform a recommended set of rights:

    Hosted two co-design sessions with young people to engage them in the development of
    recommended rights

    Reviewed “Participant Rights and Responsibilities” documents from service providers to get a broad
    understanding of the kind of rights typical for young people accessing programs

    Researched state, national, and international guidance on standards of care and treatment of youth
    and young adults

The OHY embraced the guiding principle that residential programs should support a safe, affirming,
comfortable, and supportive environment for young people, with a particular focus on the experiences
of young people of color and those who identify as lesbian, gay, bisexual, transgender,
queer/questioning, nonbinary, intersex, and others (LGBTQ+), as these youth are over-represented in the
homeless youth population.

Why Do Rights Matter?
A right is something guaranteed to a person and applies to everyone equally. Rights exist to protect
people from being treated poorly or unfairly. While everyone in Washington enjoys protection under
federal, state and local laws that ensure freedom from discrimination and fair treatment in public
accommodations such as schools and government offices, there is a need for more extensive guidance
on the treatment of young people experiencing homelessness when being served in residential
programs.

The quality of treatment that young people receive has a profound long-term impact on their wellbeing.
Adolescence (ages 12 through 24) is a key developmental window where significant changes are
happening physically, emotionally, psychologically and socially. It is a period that includes the
development of incredible strengths, such as resilience, creativity and resourcefulness. It is also a time
of heightened sensitivity where the brain is more vulnerable to damage from physical harms, like drugs
or environmental toxins, or psychological ones, like trauma and stress. 1 Equally, it is more responsive to
positive influences, making interventions that occur during this time significantly influential on a young
person’s success and stability into adulthood.

Experiencing homelessness during adolescence can have a deep and enduring impact on a person’s
life. Research demonstrates that youth homelessness is characterized by high levels of vulnerability,
with young people of color and those who identify as LGBTQ+ at greater risk of harm:




1 Steinberg, Lawrence, “Age of Opportunity, Lessons from the New Science of Adolescence,” (2015),

https://psycnet.apa.org/record/2014-35308-000


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    Black or African American youth have an 83% higher risk of experiencing homelessness.

    LGBTQ+ youth have a 120% higher risk of experiencing homelessness. 2

    Youth who identify as both LGBTQ+ and black or multiracial experience some of the highest rates
    of homelessness. 3

    53% of homeless LGBTQ+ youth have attempted suicide. 4

    Despite non-discrimination policy advances for LGBTQ+ communities, many LGBTQ+ survivors of
    intimate partner and sexual violence continue to experience discrimination and further violence
    when attempting to access care. The National Coalition of Anti-Violence Programs (NCAVP) found
    that 44% of LGBTQ+ survivors who attempted to access emergency shelter were denied mostly due
    to a lack of gender-inclusive programs. 5

    Youth experiencing homelessness have a higher risk of being in a gang, using heroin, feeling
    depressed, attempting suicide or experiencing trauma and violence than their housed counterparts
    do. 6

Given the heightened vulnerability of young people experiencing homelessness, coupled with the
unique and enduring development that occurs during adolescence, it is imperative to set and follow
high standards in programs that provide housing and services to young people.




2 Morton, M.H., Dworsky, A., & Samuels, G.M., "Missed Opportunities: Youth Homelessness in America - National Estimates," IL:

Chapin Hall at the University of Chicago, (2017), https://voicesofyouthcount.org/wp-content/uploads/2017/11/VoYC-National-
Estimates-Brief-Chapin-Hall-2017.pdf
3 Morton, M. H., Samuels, G. M., Dworsky, A., & Patel, S., "Missed Opportunities: LGBTQ Youth Homelessness in America,"

(2018), Chapin Hall at the University of Chicago, https://www.chapinhall.org/wp-content/uploads/VoYC-LGBTQ-Brief-
FINAL.pdf
4 Michelle Page, Forgotten Youth: Homeless LGBT Youth of Color and the Runaway and Homeless Youth Act, 12 Nw. J. L. &

Soc. Pol'y. 17 (2017). http://scholarlycommons.law.northwestern.edu/njlsp/vol12/iss2/2
5 National Coalition of Anti-Violence Programs (NCAVP). (2016). Lesbian, Gay, Bisexual, Transgender, Queer, and HIV-Affected

Intimate Partner Violence in 2015. New York, NY: Emily Waters. https://avp.org/wp-
content/uploads/2017/04/2015_ncavp_lgbtqipvreport.pdf
6 Centers for Disease Control and Prevention’s (CDC) Youth Risk Behavior Surveillance System (YRBSS);

https://www.cdc.gov/healthyyouth/data/yrbs/index.htm


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What Young People Have to Say
Tacoma Chapter of The Mockingbird Society
The Mockingbird Society Tacoma Chapter consists of young people who have been in foster care,
experienced homelessness or both. During the 2019 Youth Leadership Summit, they described harmful
experiences they and their peers have had in young adult shelters and requested that staff receive
training and that the effectiveness of trainings be evaluated.

In September 2019, as a follow-up to the Summit, OHY
held an interactive session with 12 young people from           “They treat me slightly
the Tacoma Chapter to invite their input on a set of rights
that might improve their experiences in shelter.
                                                                different due to my mental
                                                                disability or because I am a
Here are examples of harmful experiences in shelters
that young people described:
                                                                person of color.”

   Needs not being understood or met, especially for                   — Youth in Tacoma
   youth who have a disability

   Youth of color and those who identify as LGBTQ+ being most impacted by negative interactions

   Young people of color feel out of place because of structural racism, adultism, and inequity

   Staff do not listen or express concern for their struggles

   Being denied services

   Not being able to hold onto possessions

   Losing connection to education

   Being physically hurt

   Experiencing unsafe living conditions

   Not having an address

The Tacoma Chapter believes that shelter programs should provide a safe and trusting environment,
treat all clients with dignity, and ultimately support them in achieving stability.

Informed by their experiences, participants recommended several areas for consideration in a set of
rights:

   Right to Racial Equality: The group suggested that there be space created for staff and clients to
   reflect on their actions, words, approaches, and ways in which their micro-aggressions might affect
   others. Participants noted that racial issues are often considered to be stemming from a few “bad




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   actors” rather than recognized as systemic. They emphasized the need to acknowledge the impact
   of white supremacy on all our biases and thoughts.

   Language Interpretation: Young people recommended having the right to an interpreter, both for
   language and communication style. If people do not have access to someone who understands
   them, then they cannot assess their basic needs.

   Right to a Fair Chance: The group cited intellectual or physical disabilities or illness as factors that
   can limit opportunities for young people.

   Relatable Staff: Having staff who can relate to program participants is important in creating a
   supportive and welcoming environment. Staff should reflect the population they serve in race,
   gender identity and lived experience.

   Life Skills Support: Coaching and support are necessary to help young people learn life skills, such
   as good hygiene, laundry, etc.

Youth for Youth Board
The Youth for Youth Board (Y4Y) is an advisory group to the rural Balance of State Continuum of Care
Youth Homelessness Demonstration Program. Young people who serve on this advisory board reside
in the 23 most rural counties in the state. The OHY held a session with this group in August 2019 to
invite their input on this project.

Y4Y board members shared both positive and                  “I was talked down to by a
negative experiences they have had in programs,
offering insight into the types of interactions,            staff person who abruptly
expectations, and environments that provide a safe,         asked me ‘can you read?’”
affirming, comfortable, and supportive environment.
                                                            - Member of the Y4Y board
Y4Y members described negative experiences they
have had in seeking help for their situations:

   Inadequate support

   Lack of transparency

   Disrespectful care

   Being denied access to medical care due to religious differences/preferences of adult providers

   Being a minor and not being informed of legal rights; getting questioned multiple times without
   protection of a lawyer

   Being a minor and not being able to be independent and self-advocate; needing help due to laws
   regarding age, yet not having the services available due to age

   Lack of trauma-informed care



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   Being treated like a criminal

   Being talked down to

   Adults taking control of situations and information

   Staff not being able to identify preferred religion because of their views of what religion should be

   Being denied a certain part of race because personal appearance doesn’t match

Y4Y members also shared times that they felt safe and supported, and what key elements contributed
to those experiences:

   Acceptance

   Ability to celebrate one's culture and identity

   Friendliness

   Affirmation and respect

   Knowing someone has your back

   Love—from others and self

   Having dietary restrictions validated and respected

   Planning for the future and feeling hopeful

   Giving youth power—being involved in meetings regarding services and care

   Ability to hold each other accountable-- youth and providers both growing and learning together

   Access to information

   Peer support

   Choice

   Trust

   Opportunity to learn how to live a happy life

   Building core values for healthy long-lasting relationships

   Validation — being head and believed




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State, National and International Practices
Office of Homeless Youth Grant Agreements
The Office of Homeless Youth partners with community-based organizations and local governments to
provide services and housing to youth and young adults throughout the state. Through grant
agreements, OHY provides funding and guidance on the operations and expectations of programs.
Existing grant agreements include the following requirements related to the treatment of youth
participants.

Confidentiality
Grantees must have policies and procedures in place that cover at a minimum the confidentiality of
both written and electronic files and describe when and how participants' information can be shared.
Grantees must adhere to applicable state and federal laws concerning the sharing of personal
information.

Grievances
Grievance policies and procedures, which include a participant's right to review decisions and present
concerns to program staff not involved in the grievance, must:

   Clearly describe how participants can request a review or report concerns

   Be accessible to all participants seeking or receiving services

   Communicates process for submitting grievances that do not require the participant to submit the
   grievance to staff or volunteers for whom the grievance is against

   Identify the process for keeping written records of complaints and their resolution

Participant-Centered Services
   Services are individualized and responsive to the needs of each participant

   Services are voluntary and build on the strengths and resources of participants, respecting their
   autonomy

   Grantees must periodically administer a participant satisfaction survey to program participants to
   collect feedback on program service and delivery

Positive Youth Development
Grantees must demonstrate competency in Positive Youth Development theory and practice, including:

   Understanding child and adolescent brain development

   Fundamentals of fostering resilience

   Emphasizing positive and supportive relationships


 RIGHTS OF YOUTH AND YOUNG ADULTS IN RESIDENTIAL PROGRAMS                                              8
   Mentoring and rapport building

   Building on young people’s strengths and abilities

   Connecting youth to leadership opportunities

   Partnering with young people to develop programming

   Cultivating internal and external protective factors

   Creating meaningful opportunities for engagement

   Meeting youth where they are

Trauma-Informed Care
Grantees must demonstrate competency in trauma-informed care, including:

   Emphasizing physical, psychological and emotional safety

   Understanding the neurobiology of trauma

   Understanding of acute versus complex trauma

   Recognizing the symptoms of trauma and post-traumatic stress disorder (PTSD)

   Responding to the impact of trauma

   Understanding of power and control cycles

   Rebuilding a sense of control or empowerment

   Integrating knowledge of trauma into organizational policies, practices and procedures

   Resisting re-traumatization

Harm Reduction
Grantees must demonstrate competency in harm reduction principles and practices, including:

   Emphasizing health and quality of life

   Knowledge of practical, developmentally appropriate strategies for reducing negative
   consequences associated with high-risk behavior, including drug use

   Providing accurate and comprehensive reproductive health, sexually transmitted infection/disease
   (STI/STD) information and resources

   Facilitating access to health screenings, medical care and treatment

   Meeting young people where they are with regards to stages of change


 RIGHTS OF YOUTH AND YOUNG ADULTS IN RESIDENTIAL PROGRAMS                                        9
   Addressing motivations for high-risk behavior along with the behavior itself

   Fostering an environment where young people feel safe discussing their experiences without fear of
   judgment or reprisal

   Being non-coercive in the provision of services

   Resisting the stigmatization of youth engaged in high-risk behavior or those with mental health or
   substance use issues

   Not ignoring real and tragic harms associated with high-risk behavior or drug use

Culturally Responsive
Grantees must demonstrate a commitment to being culturally responsive by:

   Being informed by and responsive to the cultural experiences, beliefs, values, and norms of all youth

   Affirming the identities of LGBTQ+ youth and youth of color

   Providing opportunities for youth to maintain cultural, social, and spiritual relationships with their
   community

   Providing intentional opportunities for youth to discuss their experiences of racism, sexism,
   homophobia, transphobia, and other "isms" that contribute to oppression

   Ensuring services and resources are equitable and linguistically accessible

   Playing an active role in examining and addressing organizational policies, practices, which may be
   negatively impacting youth of color and LGBTQ+ youth

   Supporting a youth’s right to self-determination

   Believing that youth are experts about their own lives

   Disaggregating data by race, ethnicity, sexual orientation, and gender identity to identify and
   address disproportionality in outcomes

   Employing a workforce that reflects and is responsive to communities served

   Actively working to end all forms of oppression

   Implementing and using "Protocols for Safe and Affirming Care of LGBTQ" youth as developed by
   the Center for Children and Youth Justice (CCYJ).




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Participant Rights and Responsibilities Policies
Agencies that contract with the Office of Homeless Youth are required to have rights and
responsibilities in writing, readily available to participants, and explained to participants at intake or
when reasonably possible. These policies serve as an agreement between the youth participant and the
organization regarding expectations from the young person while in the program, and in turn, what the
young person can expect from the organization. The rights granted to program participants through
this mechanism serve as a type of informal contractual agreement, not upheld by the law.

In reviewing the Participant Rights and Responsibilities documents of multiple youth-serving
organizations, OHY identified a core set of rights that were fairly consistent across programs. They
include:

    Respectful Treatment: This relates to ensuring that participants receive services without regard to
    race, color, ancestry, national origin, gender, sexual orientation, marital status, religion, disability,
    and gender identity. It also includes offering reasonable accommodations for people with
    disabilities.

    Religion: This right provides the participant an opportunity to practice the religion of their choice
    and have the right to refuse participation in any religious practice.

    Grievance: This gives participants the right to use the organization’s grievance procedures to raise
    any concerns.

    Privacy: This right protects participants from the invasion of privacy and treats their clinical and
    personal information confidentially. In some cases, it allows participants the right to review their
    client records and clarify information within their case file.

These rights set a baseline; however, they are not standard across programs.

Center for Children and Youth Justice, eQuality Project
The Center for Children and Youth Justice's eQuality Project is a Washington state effort to improve the
lives of LGBTQ+ youth in Washington's child welfare and juvenile justice systems. Through extensive
engagement with LGBTQ+ youth, the project developed a set of protocols to serve as a guide for
professionals, volunteers, and caregivers on the critical components to ensure that LGBTQ+ youth
receive equitable, affirming, and safe treatment.

While the "Protocols for Safe & Affirming Care" 7 were developed to address the care of youth in child
welfare and juvenile justice, they are suitable to adapt for all systems caring for youth, including
homeless youth services. The protocols in their entirety provide an important resource for
organizations that serve young people. Below is an excerpt from the protocols on policies regarding the




7 Oakley, Nicholas, Center for Children & Youth Justice, eQuality Project, "Protocol for Safe & Affirming Care, Improving the

Lives of LGBTQ+ Youth in Washington State's Child Welfare and Juvenile Justice Systems," (January 2017),
https://ccyj.org/wp-content/uploads/2017/03/Protocol-for-Safe-Affirming-Care.pdf


 RIGHTS OF YOUTH AND YOUNG ADULTS IN RESIDENTIAL PROGRAMS                                                                   11
rights of youth that can be directly applied to residential programs that serve youth experiencing
homelessness.

Direct excerpt from the eQuality Protocols:

"Rights of Youth Policies

The policies in this component are designed to protect youth’s health, safety, and wellbeing by prohibiting
discrimination, ensuring youth can live consistent with their identity, and safeguarding youth’s privacy.
Parents and guardians, of course, also have important rights. Actual or perceived conflicts may arise
between the rights of youth and rights of parents. In these circumstances, users of the Protocol should
carefully consider all factors and consult with their LGBTQ+ Leads, legal counsel, and/or CCYJ, while
recognizing that the health, safety, and well-being of youth is the paramount priority.

"Identification. Professionals, volunteers, and caregivers will acknowledge, respect, and uphold the right
of youth to openly identify as LGBTQ+ or any other identity and to live free from attempts to change how
they identify.

"Anti-Discrimination. Professionals, volunteers, and caregivers will acknowledge, respect, and uphold the
right of youth to live free from discrimination and the right of LGBTQ+ youth to equitable services, care,
placement, treatment, and benefits as non-LGBTQ+ youth. Professionals, volunteers, and caregivers will
not deny youth any of these because of their sexual orientation, gender identity, or gender expression.

"Dress. Professionals, volunteers, and caregivers will acknowledge, respect, and uphold the right of youth
to wear clothing consistent with their gender identity. For example, when youth are required to wear
gender-specific uniforms, they will be permitted to select the uniform that most closely aligns with their
gender identity.

"Names. Professionals, volunteers, and caregivers will acknowledge, respect, and uphold the right of
youth to designate the appropriate name for themselves and will refer to youth by the designated name in
instances in which a first name is used and use of a legal name is not legally required.

"Pronouns. Professionals, volunteers, and caregivers will acknowledge, respect, and uphold the right of
youth to determine the appropriate pronoun for themselves and will use that pronoun.

"Privacy. Professionals, volunteers, and caregivers will acknowledge, respect, and uphold the right of
youth to not disclose their sexual orientation or gender identity.

"Safer facility access. Professionals, volunteers, and caregivers will acknowledge, respect, and uphold
the right of youth to use sex-segregated facilities, such as a restrooms and locker-rooms, consistent with
their gender identity.

"Ensuring Safe & Affirming Housing for LGBTQ+ Youth"To ensure professionals, volunteers, and
caregivers meet the specific housing needs of LGBTQ+ youth.

"Screening of caregivers. Agencies or organizations responsible for supervising or licensing caregivers
will explicitly verify and confirm that prospective caregivers and placements will uphold the basic rights
of youth as outlined in “Rights of Youth” in the Protocol.


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"Safer searches. When a search of a youth is necessary and legally permitted, professionals will allow
transgender or intersex youth to choose the gender of the person who will search them.

"Isolation as a last resort. Professionals, volunteers, and caregivers will not use isolation or segregation
as a default means to protect LGBTQ+ youth from violence or harassment. In consultation with youth
impacted, professionals, volunteers, and caregivers will work to identify alternative means of protection.
Isolation will be a last resort and minimized.

"Safer facilities. Professionals, volunteers, and caregivers will ensure youth are able to use gender-
segregated facilities, such as restrooms and locker rooms, consistent with their gender identity.
Transgender, intersex, and youth with privacy concerns will be permitted to shower separately from other
youth."




"At the Intersections: A Collaborative Resource on LGBTQ Youth
Homelessness,"8
True Colors United provides guidance on promoting the inclusion of LGBTQ+ youth in any program.
Much of the guidance mirrors that of the Center for Children and Youth Justice's eQuality protocols,
such as using appropriate pronouns, respecting confidentiality, and providing safe spaces. In addition,
they recommend the following:

    In interacting with youth, professionals should have respect for youth expertise and create space
    for youth to make choices that staff might disagree with.

    At an administrative level, all organizational forms should reflect a difference between assigned
    sex, gender identity, and sexuality.

    Physical space should be designed to communicate safety and care of LGBTQ+ youth, for example,
    creating non-gendered spaces, such as restrooms, when possible. Organizations should hire
    LGBTQ+ staff, particularly LGBTQ+ youth of color who have experienced homelessness.




8 Price, C., Chanchan, D., Wheeler, C., Seip, N., & Rush, J, (Eds.), "At the Intersections: A Collaborative Resource on LGBTQ Youth

Homelessness (2nd Edition)," True Colors United and the National LGBTQ Task Force, (2019), https://truecolorsunited.org/wp-
content/uploads/2019/04/2019-At-the-Intersections-True-Colors-United.pdf


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World Health Organization, Global Standards for Quality Health-
Care Services for Adolescents
The World Health Organization recommends the implementation of national quality standards to
transform how health systems respond to the unique health needs of adolescents. 9 In the standards, a
set of health-related rights for adolescents should include, at a minimum, the following set of rights,
excerpted from the WHO standards:

"Care that is considerate, respectful and non-judgemental of the adolescent’s unique values and beliefs.
Some values and beliefs are commonly held by all adolescents or community members and are
frequently cultural and religious in origin. Others are held by the adolescent client alone. Strongly held
values and beliefs can shape the care process and how adolescents respond to care. Thus, each health-
care provider must seek to provide care and services that respect the differing values and beliefs of
adolescents. Also, health-care providers should be non-judgemental regarding adolescents’ personal
characteristics, life style choices or life circumstances.

"Care that is respectful of the adolescent’s need for privacy during consultations, examinations and
treatments. Adolescent privacy is important, especially during clinical examinations and procedures.
Adolescents may desire privacy from other staff, other patients, and even family members. Staff
members must learn their adolescent clients’ privacy needs and respect those needs.

"Protection from physical and verbal assault. This responsibility is particularly relevant to very young
adolescents and vulnerable adolescents, the mentally ill, and others unable to protect themselves or
signal for help.

"Information that is confidential and protected from loss or misuse. The facility respects information as
confidential and has implemented policies and procedures that protect information from loss or misuse.
Staff respect adolescent confidentiality by not disclosing the information to a third party unless legally
required, by not posting confidential information or holding client-related discussions in public places.

"Non-discrimination, which is the right of every adolescent to the highest attainable standard of health
and quality health care, without discrimination of any kind, irrespective of the adolescent’s or his or her
parent’s or legal guardian’s race, colour, sex, language, religion, political or other opinion, national, ethnic
or social origin, property, disability, birth or other status.

"Adolescent participation in care processes. Unless the decision-making capacity is delegated by law to
a third party, or the adolescent lacks decision-making capacity as assessed by the relevant authority, the
adolescent decides about all aspects of care, including refusing care. The adolescent also decides which
family member and friends, if any, participate with him or her in the care process. Adolescents’
involvement in care is respected irrespective of whether or not the adolescent has a legal capacity for
decision-making. An adult’s judgement of an adolescent’s best interests cannot override the obligation to
respect all rights of adolescents as stipulated in the Convention of the Rights of the Child. This includes


9 World Health Organization, "Global Standards for Quality Health-Care Services for Adolescents, Volume 1: Standards and

Criteria," (2015),
https://apps.who.int/iris/bitstream/handle/10665/183935/9789241549332_vol1_eng.pdf;jsessionid=5C43D0E2A0AEB9CD7C
43CC0C66F7975A?sequence=1


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the right of the adolescent who is capable of forming his or her own views to express those views freely
in all matters affecting him or her, and having those views given due weight in accordance with the age
and maturity (see also evolving capacities). The facility supports and promotes adolescent involvement
in all aspects of care by developing and implementing related policies and procedures."




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Recommendations
Overview
This report describes multiple sources of input and guidance: existing OHY grant agreement
expectations; program participant rights; state, national, and international practices; and most
importantly, recommendations from young people. This report uses the resources mentioned above to
establish a baseline or core set of rights. The OHY will build on that baseline standard through
collaboration with individual agencies, additional education, outreach, and tools to develop a shared
understanding of the standards and tools to measure implementation.

The OHY recommends the following:

1. Include a standard set of rights in OHY contracts with all programs serving unaccompanied youth
   and young adults experiencing homelessness. Agencies should provide youth with a copy of their
   rights as part of the intake process. The components of a standard set of rights are outlined in the
   section below.

2. In addition to the standard, or baseline set of expectations, OHY contracts should require that
   agencies co-develop additional rights and expectations with youth participants. This approach
   ensures that the unique needs of young people in each community are represented while also
   promoting collaboration and a shared understanding of needs among program participants and
   professionals within agencies.

3. Conduct outreach and develop tools to improve communication and increase compliance with
   standards. With additional capacity, the OHY could foster continued discussion with service
   providers and young people to ensure that standards are brought to life in practice and that tools
   are in place for OHY to measure compliance.

The majority of youth who engaged in this work recommended that rights become legal standards, to
ensure they are broadly extended and enforced. OHY considered this option and understands that
establishing rights through OHY contracts will have limits, as organizations that are not funded by OHY
would not be held to these requirements. OHY's recommended approach should be considered an
initial step to provide immediate protections and an opportunity for service providers and youth to learn
how to refine and measure them. The issue of establishing these rights into law should be revisited as
greater experience and understanding is gained.

Standard Set of Rights
The following are rights that should be included in OHY contracts. Many of these are in existing OHY
contracts as expectations of grantees; however, they are not articulated as rights of participants who
access the programs.

   Adoption of the Center on Children and Youth Justice's eQuality Protocols for Safe and Affirming
   Care for LGBTQ+ youth

   Adoption of protocols for youth of color that parallel the eQuality Protocols for LGBTQ+ youth.
   These should include:


 RIGHTS OF YOUTH AND YOUNG ADULTS IN RESIDENTIAL PROGRAMS                                            16
 •   Culture identification: The right of youth to identify openly with their culture and to live free from
     attempts to change how they practice their ethnic culture

 •   Anti-Racism: The right of youth to live free from racism and the right of youth of color to
     equitable services, care, placement, treatment, and benefits as non-youth of color

 •   Dress: The right of youth to wear clothing consistent with their culture (for example, policies
     related to dress shall not restrict clothing that aligns with a person's culture or religion, such as
     the wearing of a hijab)

 Affirming care: Affirming care supports, encourages, and celebrates the identities of youth
 participants, including race, culture, ancestry, national origin, gender, gender identity, sexual
 orientation, marital status, religion, and disability. Participants receive services in an equitable
 manner.

 Culturally responsive services: Participants receive services that are relevant and responsive to the
 beliefs, practices, culture and linguistic needs of participants. Staff will facilitate awareness and
 reflection of the impact of white dominant culture and how actions, words, approaches and
 microaggressions affect others.

 Privacy: Participants are protected from invasion of privacy, and their clinical and personal
 information is treated with confidentiality. Participants have the right to review their client records
 and clarify information within their case files. Participants have the right not to disclose their legal
 status.

 Grievance: The organization has a grievance policy in which participants have the right to use to
 raise any concerns. The process is straightforward, with contact information for someone the
 participant can connect with, including a supportive staff who can assist in the process. Multiple
 options are available for filing a grievance to ensure access for all.

 Youth choice and participation in service planning: Participants have the right to participate in
 service planning and to have all expectations of the service plans explained in terms
 understandable to the participant. Services and referrals are tailored to the young person's needs.
 Participants may refuse any services offered. There are no repercussions if the participant chooses
 not to participate in all services.

 Safety, respect, and non-judgment: Participants are treated in a welcoming and supportive way.
 Staff respect differing values and beliefs of participants and are non-judgmental regarding personal
 characteristics, lifestyle choices, or life circumstances. All participants have a right to feel safe,
 physically and psychologically.




RIGHTS OF YOUTH AND YOUNG ADULTS IN RESIDENTIAL PROGRAMS                                                17


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