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Esser K, Moore C, Hounsell KG, Davis A, Sunderji A, Shulman R, Maguire B, Cohen E, Orkin J. Housing Need Among Children With Medical Complexity: A Cross-Sectional Descriptive Study of Three Populations. Acad Pediatr 2022; 22:900-909. [PMID: 34607051 DOI: 10.1016/j.acap.2021.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/20/2021] [Accepted: 09/26/2021] [Indexed: 12/19/2022]
Abstract
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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Affiliation(s)
- Kayla Esser
- Child Health Evaluative Sciences, The Hospital for Sick Children (K Esser, C Moore, KG Hounsell, R Shulman, E Cohen, and J Orkin), Toronto, Canada
| | - Clara Moore
- Child Health Evaluative Sciences, The Hospital for Sick Children (K Esser, C Moore, KG Hounsell, R Shulman, E Cohen, and J Orkin), Toronto, Canada
| | - Kara Grace Hounsell
- Child Health Evaluative Sciences, The Hospital for Sick Children (K Esser, C Moore, KG Hounsell, R Shulman, E Cohen, and J Orkin), Toronto, Canada
| | - Adrienne Davis
- Division of Paediatric Emergency Medicine, The Hospital for Sick Children (A Davis and A Sunderji), Toronto, Canada
| | - Alia Sunderji
- Division of Paediatric Emergency Medicine, The Hospital for Sick Children (A Davis and A Sunderji), Toronto, Canada
| | - Rayzel Shulman
- Child Health Evaluative Sciences, The Hospital for Sick Children (K Esser, C Moore, KG Hounsell, R Shulman, E Cohen, and J Orkin), Toronto, Canada; Division of Endocrinology, The Hospital for Sick Children (R Shulman), Toronto, Canada; Department of Paediatrics, University of Toronto (R Shulman), Toronto, Canada
| | - Bryan Maguire
- Biostatistics, Design and Analysis, Research Institute, The Hospital for Sick Children (B Maguire), Toronto, Canada
| | - Eyal Cohen
- Child Health Evaluative Sciences, The Hospital for Sick Children (K Esser, C Moore, KG Hounsell, R Shulman, E Cohen, and J Orkin), Toronto, Canada; Department of Paediatrics, University of Toronto (R Shulman), Toronto, Canada; Division of Paediatric Medicine, The Hospital for Sick Children (E Cohen and J Orkin), Toronto, Canada; Edwin S.H. Leong Centre for Healthy Children, University of Toronto (E Cohen), Toronto, Canada
| | - Julia Orkin
- Child Health Evaluative Sciences, The Hospital for Sick Children (K Esser, C Moore, KG Hounsell, R Shulman, E Cohen, and J Orkin), Toronto, Canada; Department of Paediatrics, University of Toronto (R Shulman), Toronto, Canada; Division of Paediatric Medicine, The Hospital for Sick Children (E Cohen and J Orkin), Toronto, Canada.
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Hounsell KG, Moore C, Zahavi A, Arje D, Weiser N, Esser K, Netten K, Soscia J, Cohen E, Orkin J. The Experience of Housing Needs Among Families Caring for Children With Medical Complexity. Pediatrics 2021; 148:peds.2020-018937. [PMID: 34158316 DOI: 10.1542/peds.2020-018937] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Caregivers of children with medical complexity (CMC) face many stressors related to their child's medical condition(s). Financial stress and its impact on housing has been reported to be a challenge among this population. However, unique housing challenges specific to CMC, including disability accommodations in the home and housing space and layout, have yet to be examined in the literature. METHODS We conducted 20 individual semistructured interviews with parents of CMC. Interviews were recorded, coded, and analyzed by using thematic analysis to emphasize, examine, and record patterns of meaning within the data. RESULTS Eighteen mothers and 2 fathers participated in individual interviews. Two major themes and subthemes (in parentheses) were identified: (1) the impact of health on housing (housing preferences, housing possibilities, and housing outcome as a trade-off) and (2) the impact of housing on health (health of the caregiver and health of the child). Parents had preferences regarding the location and layout of their home specific to their child's illness and medical needs. In addition, parents indicated their child's illness affected their income and home ownership status, which in turn shaped their housing possibilities. The location and layout of the family home was often the result of a trade-off between the caregiver's housing preferences and possibilities. CONCLUSIONS Housing outcomes among CMC are often the result of a trade-off between housing preferences and possibilities, both of which are influenced by the child's health status. Policy changes targeting housing accessibility and affordability are vital to support the health of CMC.
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Affiliation(s)
| | - Clara Moore
- Division of Pediatric Medicine, Department of Pediatrics, Complex Care Program.,Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | | | - Danielle Arje
- Departments of Pediatrics.,Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Natalie Weiser
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Kayla Esser
- Division of Pediatric Medicine, Department of Pediatrics, Complex Care Program.,Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Kathy Netten
- Division of Pediatric Medicine, Department of Pediatrics, Complex Care Program
| | - Joanna Soscia
- Division of Pediatric Medicine, Department of Pediatrics, Complex Care Program
| | - Eyal Cohen
- Departments of Pediatrics.,Edwin S.H. Leong Centre for Healthy Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Pediatric Medicine, Department of Pediatrics, Complex Care Program.,Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Julia Orkin
- Departments of Pediatrics .,Division of Pediatric Medicine, Department of Pediatrics, Complex Care Program.,Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
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Waterston S, Grueger B, Samson L. Housing need in Canada: Healthy lives start at home. Paediatr Child Health 2015; 20:403-13. [PMID: 26527164 DOI: 10.1093/pch/20.7.403] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Housing affects the health of children and youth. One-third of households in Canada live in substandard conditions or in housing need. The present statement reviews the literature documenting the impacts of housing on personal health and the health care system. Types of housing need are defined, including unsuitable or crowded housing, unaffordable housing and inadequate housing, or housing in need of major repairs. The health effects of each type of housing need, as well as of unsafe neighbourhoods, infestations and other environmental exposures are outlined. Paediatricians and other physicians caring for children need to understand the housing status of patients to fully determine their health issues and ability to access and engage in health care. Recommendations and sample tools to assess and address housing need at the patient, family, community and policy levels are described. Canada is the only G8 country without a national housing strategy. Recommendations also include advocating for enhanced action at all levels of government and for housing-supportive policies, including a national housing strategy.
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