Housing Instability Among Families With Young Children With Special Health Care Needs

Abstract

Children with special health care needs (SHCNs) have significant medical and educational expenses affecting household finances. Housing instability can be detrimental to family well-being. Our objective was to evaluate housing instability in households of children with and without SHCNs. Cross-sectional surveys (2013-2017) in English and Spanish of caregivers with children <4 years old were conducted at 5 hospitals. The children with SHCN screener and caregiver report of child Supplemental Security Income (SSI) receipt were used to categorize children into the following groups: (1) no SHCNs, (2) SHCNs and no SSI, or (3) SHCNs and receiving SSI. Housing instability was determined by positive endorsement of ≥1 adverse circumstance: behind on rent or mortgage, or moving twice or more in the past year, or homelessness in the child's lifetime. Analyses used multivariable logistic regression models, adjusting for demographics and housing subsidies. Of 14 188 children, 80% had no SHCNs, 16% had SHCNs and no SSI, and 4% had SHCNs and received SSI. Compared with the no-SHCNs group, the SHCNs-no-SSI group but not the SHCN-receiving-SSI group experienced significantly greater adjusted odds of being behind on rent or mortgage (adjusted odds ratio [aOR] 1.28 [95% confidence interval (CI) 1.14-1.44]; P < .001), multiple moves (aOR 1.29 [95% CI 1.05-1.59]; P = .01), and homelessness (aOR 1.44 [95% CI 1.20-1.72]; P < .001). Families of children with SHCNs are at risk for housing instability. Child SSI receipt decreased the risk of housing instability among families of children with SHCNs. Protecting families of young children with SHCNs from housing instability is an important investment.