Permanent supportive housing has medical benefits for children, study finds

Key takeaways:

• Children who stayed in permanent supportive housing attended more dental visits than peers.
• Further research is needed on how such programs benefit children.

Children placed in permanent supportive housing were more likely to attend dental visits than peers in a matched cohort, according to a study published in Pediatrics.

Another article published this week in Pediatrics examined how public school students with disabilities are more likely to experience homelessness.

“The Medicaid Research Center in Pittsburgh has done really awesome work looking at a number of policies related to Medicaid and adults,” James C. Bohnoff, MD, MS, currently a pediatrician at Maine Health and formerly a resident at Children’s Hospital of Pittsburgh, told Healio. “So, it was a really good step off of that to ask what about the kids who are also benefiting from these services?”

Bohnoff and colleagues analyzed data from Pennsylvania’s Homeless Management Information System from 2011 to 2016, as well as administration data from Pennsylvania Medicaid ranging from 2008 to 2018. They matched 705 children entering permanent supportive housing against a 3,141-person comparison cohort of children who did not receive permanent supportive housing.

Children included in the intervention cohort were enrolled in Medicaid and had been enrolled in permanent supportive housing for at least 180 days. Data were available from 54 of 67 counties in Pennsylvania, but Philadelphia was not counted among them.

“We did all of this matching so that we could ask, What's the change in health care utilization in the children who receive permanent supportive housing, and how is that different than the change in utilization amongst very similar children?” Bohnoff said.

The researchers ultimately found that children and adolescents in permanent supportive housing attended more dental visits over the following 3 years after their initial enrollment than the control cohort, with a difference in difference of 12.70 visits per 1,000 person-months (95% CI, 3.72-21.67).

Children who were aged 5 years or younger upon their enrollment in permanent supportive housing also experienced a greater decrease in ED visits relative to their own control cohort, with a difference in difference of –13.16 visits per 1,000 person-months (95% CI, –26.23 to –0.1).

The findings, Bohnoff said, were “surprising.”

“The supports that are built into most permanent housing programs are all centered around the adults in the families,” Bohnoff said. “Children are kind of present in some sense, along for the ride a little bit. What [the findings] show is that even being along for the ride benefits the children in a way that we can show statistically.”

The authors concluded that the policymakers should “consider benefits to children when evaluating the overall value” of permanent supportive housing.

“For pediatricians, there has been a growing push to screen for housing insecurity,” Bohnoff said. “I think this supports that and also highlights the idea that by advocating for our programs, we're available to help move people out of housing insecurity.”

According to Bohnoff, preliminary research said “very little” about what housing programs were doing for children specifically.

“There's huge variation state to state and even within states,” Bohnoff said. “What are the specific supports that are provided through permanent housing, and which, if any, of those structures and supports are specifically aimed at children? I would love some research that goes to permanent supportive housing programs and asks them, ‘How do you interact with the children that pass through your doors?’ so we can understand whether the benefits that we saw were simply because children were in better housing conditions or if they're related more to the fact that their parents were in a more stable place.”