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Housing Need Among Children With Medical Complexity: A Cross-Sectional Descriptive Study of Three Populations
Kayla Esser1, Clara Moore1, Kara Grace Hounsell1
1Child Health Evaluative Sciences, The Hospital for Sick Children (K Esser, C Moore, KG Hounsell, R Shulman, E Cohen, and J Orkin), Toronto, Canada.
Insights
Children with medical complexity face significant housing challenges, including safety risks and affordability issues. These housing needs are more prevalent compared to children with chronic conditions or healthy peers.
Area of Science:
- Pediatric Healthcare Research
- Social Determinants of Health
- Housing Studies
Background:
- Children with medical complexity (CMC) have unique housing and accessibility needs due to medical fragility and technology dependence.
- Limited research exists on the prevalence and types of housing needs experienced by families of CMC.
- Understanding these needs is crucial for developing targeted support systems.
Purpose of the Study:
- To describe the housing needs of families with CMC.
- To compare housing needs across CMC, children with a single chronic condition (Type 1 diabetes; CT1D), and healthy children (HC).
Main Methods:
- Cross-sectional descriptive study utilizing survey methodology.
- Assessed housing suitability, adequacy, affordability, stress, and accessibility.
- Analyzed data from 490 caregivers using logistic and ordinal logistic regression, adjusting for sociodemographic factors.
Main Results:
- Caregivers of CMC reported higher risks of housing safety concerns (aOR 3.1) and using common areas as sleeping spaces (aOR 5.6).
- Families with CMC were more likely to reduce spending (aOR 4.6) or borrow money (aOR 2.9) for housing and experienced greater housing stress (aOR 3.3).
- CMC families were significantly more likely to consider moving for health/community services (aOR 15.0).
Conclusions:
- CMC are more prone to multiple housing needs than CT1D and HC, even after controlling for sociodemographics.
- This highlights a strong association between the complexity of a child's health condition and housing insecurity.
- Clinical practice and research should prioritize screening for and addressing the housing needs of CMC.
Objective:
Children with medical complexity (CMC) are hypothesized to have unique housing and accessibility needs due to their medical fragility and medical technology dependency; however, research on prevalence and types of housing need in CMC is limited. The objective was to describe housing need in families of CMC, and to compare housing need across CMC, children with one chronic condition (Type 1 diabetes; CT1D) and healthy children (HC).
Methods:
This cross-sectional descriptive study assessed housing suitability, adequacy, affordability, stress, stability, and accessibility using survey methodology. Participants were caregivers of CMC, CT1D and HC at a tertiary-care pediatric hospital. The association of housing need outcomes across groups was analyzed using logistic and ordinal logistic regression models, adjusting for income, educational attainment, employment status, community type, immigration status, child age, and number of people in household.
Results:
Four hundred ninety caregivers participated. Caregivers of CMC reported increased risk of housing-related safety concerns (aOR 3.1 [1.3-7.5]), using a common area as a sleeping area (5.6 [2.0-16.8]), reducing spending (4.6 [2.3-9.5]) or borrowing money to afford rent (2.9 [1.2-6.7]), experiencing housing stress (3.3 [1.8-6.0]), and moving or considering moving to access health/community services (15.0 [6.4-37.6]) compared to HC.
Conclusions:
CMC were more likely to experience multiple indicators of housing need compared to CT1D and HC even after adjusting for sociodemographic factors, suggesting an association between complexity of child health conditions and housing need. Further research and practise should consider screening for and supporting housing need in CMC.
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