Homeless children experience more acute and chronic conditions, and worse health status, than other low-income children (Weinreb, et al., 1998; Parker et al., 1991; Wood et al., 1990). We reviewed paper and electronic medical records of all subspecialty referrals made for 1998 patients of the New York Children's Health Project. All were in homeless or domestic violence shelters. Nearly one-fourth (23.1%) of 2,205 new patients required at least one referral. We focused on 183 patients requiring 2 or more different referrals within 3 months of initial pediatric assessment. Demographically, they were 96% African-American or Hispanic; mean age 68 months (range 1 month to 17 years 9 months); 100% Medicaid eligible. At least 7 required hospitalization, and 8 needed surgery. A developmental specialist and a pediatrician independently rated severity of conditions on a 3 point scale (3=most severe) using our pediatric modification of the RAND SF-36 Health Survey. Mean severity was 2.5. Significant behavioral-developmental problems affected 69% of patients. Conditions included hearing loss (8 cases, age range to 15 years), cardiac anomalies (6), club foot (4), seizure disorder (3); strabismus (identified at 7 years), hydrocephaly (patient shunted at 15 months), scoliosis, and renal disease. These 5% of new patients used 38% of all specialty referrals for 1998. We conclude that the level of unmet medical need for homeless and other high social risk children is often severe. Continued failure to provide adequate medical care may result in permanent disability and life limitation. Implications for health policy and financing are discussed.
Learning Objectives: Participants will better understand the severity of health conditions presented by children new to the homeless shelter system. Participants will better understand the impact of inadequately treated health problems on the behavior and development of medically underserved children.
Keywords: Access to Health Care, Homelessness
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.