1 Youth Experiencing Homelessness Presenting to an Urban Paediatric Emergency Department: A Descriptive Study

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Abstract Background Youth experiencing homelessness (YEH) have high rates of both mental and physical health concerns. This population faces multiple barriers in accessing care, resulting in unaddressed needs and reliance on Emergency Departments (ED). In Canada, the use of the paediatric ED by YEH has not been well described, and there is no data exploring the effects of the COVID-19 pandemic lockdown on ED attendance by this population. Objectives This study aims: 1) To review the frequency/nature of the presentations to the paediatric ED by YEH; 2) To compare pre- and post-COVID-19 data. Design/Methods Medical records were searched for ED encounters where a patient identified a youth shelter as their address and/or had terms documented such as “homeless”, during two time periods: pre-COVID-19 (May 1, 2018–March 15, 2020) and post-COVID-19 lockdown (March 16, 2021–Jan 31, 2022). Pertinent details of the encounters were documented, including chief complaint (CC). Descriptive statistics were used, as well as comparative analysis of the two time periods. Results A total of 1103 encounters were included. Over the total 45-month study time period, CCs were split between mental health-related (n=562, 50.9%) and physical health-related presentations (n=541, 49%). Of the mental health CCs, 396 (70.4%) were documented as “depression/overdose/suicidal/self-harm”. The most common CCs related to physical health were injuries (n=127, 23.4%), and pain (n=126, 23.2%). YEH most commonly attended the paediatric ED between 17:00-00:00 (n=504, 45%), and were triaged as CTAS 3/urgent (n = 676, 61.2%). Of those who completed an Ask Suicide-Screening Questionnaire (ASQ) (n=303), 45.8% (n=139) had an acute positive screen/imminent risk identified. The most common principal diagnoses documented at disposition were related to injuries/assault/pain (n= 224, 20%), and suicide attempt/self-harm (n=196, 17.7%). Of the 166 outpatient referrals made at discharge from ED, 105 (63%) were to mental health/psychiatry. While overall there were fewer ED encounters for this population “post COVID-lockdown” (n=465) as compared to “pre-COVID” (n=638) (p-value <0.05), there was a significant reduction in mental health-related CCs (pre-COVID n=365, post-COVID n=197; p-value <0.05), with no significant reduction in physical-related CCs after the pandemic lockdown (pre-COVID, n=273, n=268). Conclusion YEH utilize the paediatric ED for both their mental and physical healthcare and frequently report suicide risk. The findings that lower attendance to the paediatric ED for mental health-related concerns followed the pandemic lockdown, while physical health encounters remained steady, may reflect increased barriers to care or novel methods of mental health care delivery post-pandemic.

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