How Do Healthcare Providers Address the Needs of Children and Families Experiencing Housing Instability? A Multisite Qualitative Study

Background Over two million children experience homelessness annually in the United States, often disrupting their healthcare. The purpose of this study, spearheaded by the National Network to End Family Homelessness (NNEFH), was to understand the role of primary care providers who serve children and families experiencing homelessness. Specifically, we sought to describe best practices for screening for housing-unstable families and providing optimal care for these patients once identified. MethodsWe conducted a qualitative study employing semi-structured, in-depth interviews with clinicians and administrators working in healthcare organizations serving children and families. Recruitment occurred by invitation from NNEFH Health Committee members. Stratified purposeful sampling ensured representation from a range of organizations that provided care to persons experiencing homelessness. The selection criteria captured rural and urban locations, and three organizational types: academic health affiliates, community health centers, and Health Care for the Homeless (HCH) sites. We analyzed interview transcripts through a deductive coding process and grounded theory approach, facilitated by Dedoose software.ResultsWe completed 13 in-depth interviews procuring both qualitative and quantitative data. Of the 13 clinics there were 4 academic health affiliates, 5 community health centers, and 4 HCH sites. Clinics provided services to a broad range of clients including children, immigrants, elderly, pregnant mothers, and LGBTQ+ community members. The estimated number of yearly visits varied from 1,000 to 30,000, with most clinics offering both appointment-based and walk-in options. All clinics performed housing screening, applying a mix of validated and unique tools based on their patient population; also providers were well-versed on common health challenges among persons experiencing homelessness. Most clinics reported that they addressed mental health needs of children and of their caregivers. Every clinic identified at least one barrier to optimum care provision, most commonly: access to reliable transportation, communication with patients, lack of affordable housing, and patient load and complexity. As one participant described, “one case manager for like 7,500 primary care visits, not to mention the specialty case visits, it\u27s just like an impossible task for just one person.” ConclusionThis study specifically examined strategies for optimum care provision for housing-unstable children and families. Similar to existing literature on adults experiencing homelessness, the most prominent challenges reported in this study were structural and resource barriers. In developing technical assistance for sites similar to those in our study, interviewees recommended support for the development and maintenance of collaboration across sectors and mechanisms for facilitating policy and systems change