Understanding the health care needs of children in shelter

Objective: Children experiencing homelessness are a vulnerable population with poorer health than their housed counterparts. We sought to understand the health care needs of children in shelter, and to compare maternal and volunteer health care providers perspectives on the goals of programs designed to address those needs. Methods: A qualitative study design was employed. We conducted in-depth interviews of mothers in shelter (N=24) and engaged healthcare providers who volunteer to provide services in the collaborating shelters (N=54) through an on-line questionnaire. Maternal interviews were audio-recorded, transcribed verbatim and analysis facilitated by NVIVO 9 Software. Freelisting questions were incorporated into the in-depth interviews and on-line questionnaire. Freelisting responses were analyzed using Anthropac 1.0 to identify salient terms for each subgroup. Results: Analysis of maternal semi structured interviews yielded several important pediatric health care needs including; insurance, well child care, doctors, and immunizations. Various themes surrounding the shelter environment emerged, including the need for infection control, improved physical conditions, better nutrition, and ways to help families cope with behavioral issues. Free listing allowed for a comparison of maternal perspectives and provider perspectives on programmatic goals. Conclusions: Mothers of children in shelter identified various pediatric health care needs, including many unique to the shelter environment. Mothers described unmet needs and propose goals for programs to improve health care for their children, which share some commonality with the perspective of volunteer health care providers. Areas of overlap include, health screening and access to medical and dental care.