Runaway Youth: Caring for the Nation's Largest Segment of Missing Children Thresia B
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CLINICAL REPORT Guidance for the Clinician in Rendering Pediatric Care Runaway Youth: Caring for the Nation’s Largest Segment of Missing Children Thresia B. Gambon, MD, MPH, MBA, FAAP,a Janna R. Gewirtz O’Brien, MD, FAAP,b COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, COUNCIL ON COMMUNITY PEDIATRICS The largest segment of missing children in the United States includes abstract runaways, children who run away from home, and thrownaways, children who are told to leave or stay away from home by a household adult. Although aCitrus Health Network, Miami, Florida; and bDepartment of Pediatrics, estimates vary, as many as 1 in 20 youth run away from home annually. These University of Minnesota, Minneapolis, Minnesota unaccompanied youth have unique health needs, including high rates of Clinical reports from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external trauma, mental illness, substance use, pregnancy, and sexually transmitted reviewers. However, clinical reports from the American Academy of infections. While away, youth who run away are at high risk for additional Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent. trauma, victimization, and violence. Runaway and thrownaway youth have high Drs Gambon and Gewirtz O’Brien drafted, reviewed, and revised the unmet health care needs and limited access to care. Several populations are manuscript, approved the final manuscript as submitted, and agree to at particular high risk for runaway episodes, including victims of abuse and be accountable for all aspects of the work. neglect; lesbian, gay, bisexual, transgender, and questioning youth; and youth The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking in protective custody. Pediatricians and other health care professionals have into account individual circumstances, may be appropriate. a critical role to play in supporting runaway youth, addressing their unique All clinical reports from the American Academy of Pediatrics health needs, fostering positive relationships within their families and with automatically expire 5 years after publication unless reaffirmed, other supportive adults, and connecting them with available community revised, or retired at or before that time. resources. This report provides clinical guidance for pediatricians and other This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed health care professionals regarding (1) the identification of adolescents who conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process are at risk for running away or being thrown away and (2) the management of approved by the Board of Directors. The American Academy of the unique medical, mental health, and social needs of these youth. In Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication. partnership with national, state, and local resources, pediatricians can DOI: significantly reduce risk and improve long-term outcomes for runaway youth. https://doi.org/10.1542/peds.2019-3752 Address correspondence to Thresia B. Gambon. E-mail: tbgambon@ me.com PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). INTRODUCTION Copyright © 2020 by the American Academy of Pediatrics The largest segment of missing children in the United States includes FINANCIAL DISCLOSURE: The authors have indicated they have no runaways, children who run away from home, and thrownaways, children financial relationships relevant to this article to disclose. who are told to leave or stay away from home by a household adult.1,2 This report aims to provide clinical guidance for pediatricians regarding (1) the To cite: Gambon TB, Gewirtz O’Brien JR, AAP COMMITTEE identification of adolescents who are at risk for running away or being ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, COUNCIL ON COMMUNITY PEDIATRICS. Runaway Youth: thrown away and (2) the management of the unique medical, mental Caring for the Nation’s Largest Segment of Missing health, and social needs of these youth. Children. Pediatrics. 2020;145(2):e20193752 Downloaded from www.aappublications.org/news by guest on September 24, 2021 PEDIATRICS Volume 145, number 2, February 2020:e20193752 FROM THE AMERICAN ACADEMY OF PEDIATRICS There has been a considerable a runaway episode occurs when state and by study population. As amount of research conducted in the a child leaves home without noted previously, NISMART-3 area of runaway and thrownaway permission and stays away overnight estimated a prevalence of running youth since the 2004 publication of for at least 1 night (for children away of 5.3 per 1000 children.2 In the previous clinical report “The younger than 15 years) or 2 nights another study, published in 2006 on Pediatrician’s Role in the Prevention (for children 15 years or older). A the basis of data from the 1996 wave of Missing Children.”3 This clinical thrownaway episode occurs when of the National Longitudinal Study of report expands on the previous a child is asked or told to leave the Adolescent Health, authors reported report’s discussion of youth who run home by a household adult or is that 6.4% of youth (nearly 850 000) away in the United States. Although prevented from returning home by had run away in the 12 months estimates of the prevalence of a household adult for at least 1 night before the 1996 survey.6 By using the running away vary depending on when no adequate alternative care is data from the National Longitudinal definitions, methodology, and arranged.2 Survey of Youth (1997 cohort), it was population, the 2013 National found that nearly 1 in 5 youth ran Runaway and thrownaway episodes Incidence Studies of Missing, away before age 18. A school-based are grouped together because youth Abducted, Runaway, and survey of Minnesota youth in grades often fall into both categories. Thrownaway Children (NISMART-3), 8 through 11 revealed that between Information varies depending on released by the US Office of Juvenile 4% and 7% of students had run away who is interviewed regarding the Justice and Delinquency Prevention in at least once in the previous year.7,8 circumstances; youth do not always 2017, estimated that 413 000 view the circumstances the same way Each report of a missing child made children ran away or were thrown as the guardians and/or parents to law enforcement is required by away in 2013, at a rate of 5.3 per 1000 do.20 Twenty-two percent of youth federal law to be entered into the children, comparable to previous described the episode as Federal Bureau of Investigation NISMART cycles.2,4 Other studies a combination of running away and National Crime Information Center have estimated that between 5% being thrown out.20 In this report, the (National Center for Missing and and 8% of adolescents run away 21 – term “runaway” is used to refer to Exploited Children [NCMEC]). Some every year.5 8 It is important that both categories, although the term of the reports may be regarding the pediatricians understand this “thrownaway” is occasionally used to same child because a report can be population so they can better serve be consistent with the data. made each time a child is missing. In these youth and families in clinical 2017, 464 000 reports were made practice and in the community setting. Runaways may not always be into this database. One role of the classified as missing children, making NCMEC, the national clearinghouse Unaccompanied adolescents who run it difficult to quantify the problem. and resource center for missing and away or who are asked to leave home Many runaways are not considered exploited children, is to help with have unique health needs. Before missing because guardians and/or finding these children. In 2017, the running away, many have learning parents know the whereabouts of the NCMEC assisted with more than disabilities, struggle with mental youth. Youth who run away may stay illness, experience school failure, or 27 000 cases, including 25 000 with friends or other family 21 engage with peer groups who 1,20 runaways (missingkids.org). 9 members. In addition, some participate in high-risk behaviors. runaways may not be reported The Runaway Safeline, (1–800- Many have experienced abuse or RUNAWAY), formerly known as the 10–13 missing because the guardians and/ neglect before running away. or parents are not looking for them. National Runaway Switchboard, is While away, these unaccompanied There is a small category of children a federally funded national resource minors are at high risk for who are permanently abandoned and that provides services to youth and victimization and violence; substance are often not included in data because their families (https://www. use; risky sexual behavior, including they may not be reported as missing.1 1800runaway.org/). The Safeline survival sex; further absenteeism allows runaway and homeless youth from school; and other or their parents to call for assistance DEMOGRAPHICS associated negative health or guidance; attain 24-hour referrals 9–11,14–19 consequences. The total number of youth who run to community resources, including away is difficult to measure for shelter, food banks, legal assistance, a number of reasons, including and social services agencies; and seek