Food and Housing Insecurity, Resource Allocation, and Follow-up in a Pediatric Emergency Department.

Introduction: Food and housing insecurity in childhood is troublingly widespread. Emergency departments (ED) are well positioned to identify and support food- and housing-insecure children and their families. However, there is no consensus regarding the most efficient screening tools or most effective interventions for ED use. Objective: In this cross-sectional study we aimed to investigate the implementation of a food/ housing insecurity screening tool and resource referral uptake in a pediatric ED. Methods: During the study period (March 1-December 9, 2021), there were 67,297 ED visits at the study institution, which is a freestanding children's hospital. Caregivers of patients presenting to the ED were approached for participation in the study; 1,908 families participated (2.8% of all ED visits during the study period) and were screened for food and housing insecurity. Caregiver surveys included demographic, food and housing insecurity, caregiver/patient health status, and healthcare utilization questions. Caregivers who screened positive for food and/or housing insecurity received printed materials with food and/or housing resources. We analyzed data using descriptive statistics, one-way analysis of variance, and the Pearson chi-squared test. Results: A total of 1,908 caregivers were surveyed: 416 (21.8%) screened positive for food and/or housing insecurity. Of those who screened positive, 147/416 completed follow-up surveys. On follow-up, 44 (30.0%) no longer screened positive for food and/or housing insecurity, while 15 (10.2%) reported using at least one resource referral. The most frequently reported referral utilization barrier was loss or reported non-receipt of the referral. Conclusion: This study demonstrates high food- and housing-insecurity rates among families presenting to a pediatric ED, emphasizing the urgency and necessity of screening and intervening in this environment. The food and housing insecurity change between baseline and follow-up reported here and the overall low resource uptake highlights challenges with ED-based screening and intervention efficacy.