Sasha, a 15-year-old, is brought into clinic by her case manager to be evaluated after running away. She has been in foster care for about two years due to her mother’s history of neglect and physical abuse. When asked why she ran away, Sasha answered: “I wanted to see my mother. I miss her.”
Frequently, teenagers in protective custody may run to their prior home to see family members and friends.
The largest segment of missing children includes those who run away from home (runaways) and children told by a household adult to leave or stay away from home (thrownaways). Estimates reveal as many as one in 20 youths runs away from home annually. These children and adolescents are at high risk of trauma, victimization and violence. They often have unique health needs prior to running, including history of physical trauma, mental illness and substance use.
All pediatricians are likely to see children who have run away. A new AAP clinical report discusses how pediatricians can play a critical role in identifying youths at risk of running away, caring for those who have run, and guiding families and caregivers on how to decrease the incidence of running.
The report, Runaway Youth: Caring for the Nation’s Largest Segment of Missing Childrenfrom the Committee on Psychosocial Aspects of Child and Family Health and Council on Community Pediatrics, is available at https://doi.org/10.1542/peds.2019-3752 and will be published in the February issue of Pediatrics.
Demographics, risk factors
So, who runs away? Runaways are predominantly teenage females. LGBTQ youths are disproportionally represented among runaways and those who are asked to leave home. Several populations at higher risk for running away deserve extra attention, including victims of abuse and neglect and those in protective custody.
Runaways typically leave home without permission and stay away at least one night (children under 15 years old) or at least two nights (adolescents 15 years or older). The runaway and thrownaway episodes often are grouped together because many youths fall into both categories.
Youths who run away experience higher rates of mental illness, including anxiety, depression and suicidality. There is a strong association between substance use and runaway episodes. While there is no single validated tool for runaway episodes, pediatricians should consider assessing for risk factors that can include mental illness, substance use, unstable household and history of abuse or neglect. Disengagement from school is a significant risk factor for running away.
Recommendations
For youths who have run away:
- Conduct a thorough assessment of mental health concerns, substance use, history of abuse, violence or victimization, exposure to trauma, and sexual and reproductive health needs.
- Provide comprehensive care, including gynecological care, screening and treatment for sexually transmitted infections and mental health support.
- Support and maintain awareness of programs that serve runaway youths such as the National Runaway Safeline and local resources.
For youths who are at high risk:
- Conduct a thorough history using the HEEADSSS assessment, which asks about Home, Education/Environment, Eating, Activities, Drugs, Sexuality, Suicide and Safety. Depression screening is recommended for children 12 years and older.
- If risk factors are found, intervene early to prevent the patient from running away. If the youth already has run away, explore the causes and work with him/her and the guardians to improve the situation.
- Discuss a safety plan for those likely to run, including options for safe housing, access to contraception and mental health care.
- Stay informed on resources and share support organizations with the youth and family and/or guardian. Post information in waiting or exam rooms.
Youths who run away or are thrown away make up a significant number of patients. Pediatricians should be aware of this problem and the populations at high risk. They should inquire and work with families, guardians and youths to help reduce the incidence of running.
Dr. Gambon, a lead author of the clinical report, is a former member of the AAP Committee on Psychosocial Aspects of Child and Family Health.
