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Study: Visits to pediatric ED for homelessness spike after policy change :

October 15, 2018

Emergency department (ED) visits for homelessness spiked at a Massachusetts children’s hospital after the state made it tougher for families to get into emergency shelters, a new study found.

The changes cost the state thousands of dollars in health care costs, according to the study “Pediatric Emergency Department Visits for Homelessness After Shelter Eligibility Policy Change” (Stewart AM, et al. Pediatrics. Oct. 15, 2018,

In 2012, Massachusetts shelters began requiring additional documentation of homelessness, such as sleeping in a place “not meant for human habitation,” which could include an ED.

Researchers studying ED visits for homelessness at a children’s hospital from March 2010 to February 2016 found 95% occurred after the policy change and ED visits for homelessness more than quadrupled.

After the policy change, 65% of those children did not have a medical complaint compared to 20% before the policy. ED visits cost nearly five times as much as a night in a shelter, and state insurers bore 89% of the $173,950 total cost, according to the study.

“It is important to understand the magnitude of the problem of child homelessness, the characteristics of children being seen for homelessness, the reasons for families’ homelessness, and the unintended health care costs, to enable legislators and policy makers to create more effective policies for these families in Massachusetts and throughout the United States,” authors wrote.

In a related commentary, AAP Past President Benard P. Dreyer, M.D., FAAP, noted about 2.5 million children experience homelessness, which can have significant impacts on their physical and emotional health. He called on pediatricians to advocate for these children.

“The AAP encourages pediatricians to take an active role in the health care of children in homeless families, including ensuring behavioral health and nutrition, leading efforts for programs that ameliorate the conditions in shelters, and advocating for policies to make adequate housing more available and secure for low-income families,” Dr. Dreyer wrote.

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