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. 2025 Mar;26(2):326-337.
doi: 10.5811/westjem.19435.

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

Raymen R Assaf  1   2 , Chloe Knudsen-Robbins  3 , Theodore Heyming  1   4 , Kellie Bacon  1 , Shelby K Shelton  1 , Bharath Chakravarthy  4 , Soheil Saadat  4 , Jason A Douglas  5 , Victor Cisneros  4   6   7
Affiliations

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

Raymen R Assaf et al. West J Emerg Med. 2025 Mar.

Abstract

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.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. This research was supported through a Children’s Hospital of Orange County Chief Scientific Officer (CSO) Seed Grant (Grant #16962002). This funding source was not involved in study design, data collection, data analysis, interpretation of data, manuscript drafting, or decision to submit for publication. There are no other conflicts of interest or sources of funding to declare.

Figures

Figure.
Figure.
Reported barriers to referral use.
See this image and copyright information in PMC

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