Understanding behavioral health symptoms in children experiencing housing and food insecurity

Abstract

BACKGROUND: Modifiable social needs that include housing security, housing conditions, and food security can impact children’s behavioral health. Boston Children’s Primary Care has entered into an accountable care arrangement that has allotted funds for “flexible services” to direct housing or food intervention at children with mental or behavioral health problems. OBJECTIVE: This cross-sectional study will inform our baseline understanding of our population prior to the roll out of the flexible services program in January 2020. Therefore, among primary care patients we aim to understand the associations between: 1) Behavioral health symptoms and housing status 2) Behavioral health symptoms and food insecurity METHODS: This is a cross-sectional study examining associations between behavioral health symptoms and unmet food and housing needs at Boston Children’s Primary Care. At well-care visits, caregivers completed validated screening questions regarding food and housing insecurity, as well as age-appropriate behavioral health screening forms about their child. We used descriptive statistics to examine the demographics, social needs, and behavioral health problems of our population. Bivariate and multivariate logistic regression analyses were conducted to understand the relationship between social needs and behavioral health problems. RESULTS: Our sample included 125 pediatric patients ages 2-12, 29.6% of whom were Black or African American, 31.2% were Hispanic or Latino, 63.2% were publicly insured, and 76.8% spoke English. In our sample, 12.8% of the sample experienced housing insecurity, 10.4% of the sample experienced problems with housing conditions, 13.6% of the sample experienced food insecurity, and 24.0% experienced any housing or food problem. Our sample showed that 20.0% of children had behavioral health symptoms on screening. In bivariate analyses, those with housing insecurity were more likely to experience behavioral health symptoms (OR 10.444, CI: 3.309-32.969]), those with food insecurity were also likely to experience behavioral health symptoms (OR: 2.350, CI: 1.284-4.302), and those who experienced any food or housing problem were also more likely to experience behavioral health problems (OR: 5.289, CI: 2.061-13.571). In multivariate logistic regression models that included our only significant covariate (insurance), behavioral health symptoms were only associated with housing problem and any housing or food problem.