Development of a homelessness risk screening tool for emergency department patients

Doran, Kelly M.; Johns, Eileen; Zuiderveen, Sara; Shinn, Marybeth; Dinan, Kinsey Alden; Schretzman, Maryanne; Gelberg, Lillian; Culhane, Dennis P; Shelley, Donna; Mijanovich, Tod

doi:10.1111/1475-6773.13886

Cited by 12 publications

(17 citation statements)

References 24 publications

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“…Our study fills this gap, but the 2 private information questions we examined did not perform better than previously examined public information on past homelessness in our sample. 20 Our findings highlight the inherent challenges in identifying future homelessness, including for patients themselves.…”

Section: Discussionmentioning

confidence: 79%

“…30 Differences in performance between 2 screening questions examined in this study are consistent with past research showing that various housing-related screening questions used in health care settings were not necessarily interchangeable. 31 In a prior study, 20 our research group examined the performance of a broad array of variables in identifying future homelessness and found that variables related to patient past homelessness had higher PPVs than other individual-level variables, such as those related to medical issues, behavioral health, and other social factors. We found that a 3-item screening tool that included questions about shelter use in the past 12 months, application for shelter in the past 3 months, and lifetime history of incarceration had a sensitivity of 0.83 and PPV of 0.20 in identifying shelter entry within 6 months, metrics that suggest stronger performance than the single-item questions we examined in this study.…”

Section: Discussionmentioning

confidence: 99%

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Performance of 2 Single-Item Screening Questions to Identify Future Homelessness Among Emergency Department Patients

et al. 2022

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ImportanceDespite increasing interest in assessing patient social needs in health care settings, there has been little research examining the performance of housing-related screening questions.ObjectiveTo examine the performance of 2 single-item screening questions assessing emergency department (ED) patients’ self-perceived risk of future homelessness.Design, Setting, and ParticipantsThis prospective cohort study was conducted among a randomly selected sample of adult ED patients from 2016 to 2017 in a public hospital ED in New York City. Data were analyzed from September 2019 through October 2021.ExposuresResponses on patient surveys conducted at the baseline ED visit for 2 single-item screening questions on self-perceived risk for future housing instability and homelessness were collected. One question asked patients if they were worried about having stable housing in the next 2 months, and the other question asked them to rate the likelihood that they would enter a homeless shelter in the next 6 months.OutcomesHomeless shelter entry 2, 6, and 12 months after an ED visit, assessed using shelter administrative data in the study city, which was linked with participant baseline survey responses.ResultsThere were 1919 study participants (976 [51.0%] men and 931 [48.6%] women among 1915 individuals with gender data; 700 individuals aged 31-50 years [36.5%] among 1918 individuals with age data; 1126 Hispanic or Latinx individuals [59.0%], 368 non-Hispanic Black individuals [19.3%], and 225 non-Hispanic White individuals [11.8%] among 1908 individuals with race and ethnicity data). Within 2, 6, and 12 months of the ED visit, 45 patients (2.3%), 66 patients (3.4%), and 95 patients (5.0%) had entered shelter, respectively. For both single-item screening questions, participants who answered affirmatively had significantly higher likelihood of future shelter entry at each time point examined (eg, at 2 months: 31 participants responding yes [6.5%] vs 14 participants responding no [1.0%] to the question concerning being worried about having stable housing in the next 2 months). Sensitivity of the screening questions ranged from 0.27 to 0.69, specificity from 0.76 to 0.97, positive predictive value from 0.07 to 0.27, and area under the receiver operating characteristic curve from 0.62 to 0.72.Conclusions and RelevanceThis study found that 2 single-item screening questions assessing ED patient self-perceived risk of future housing instability and homelessness had adequate to good performance in identifying risk for future shelter entry. Such single-item screening questions should be further tested before broad adoption.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Performance of 2 Single-Item Screening Questions to Identify Future Homelessness Among Emergency Department Patients

et al. 2022

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Section: Methodsmentioning

confidence: 99%

“…We used a homelessness risk screener previously developed at the study hospital 21 . The screener consists of three self‐reported items (use of a shelter or homeless drop‐in center in the past 12 months, applied for shelter in the past 3 months, and/or lifetime history of incarceration or jail stay, with any “yes” representing a positive screen) and has 83.0% sensitivity and 20.4% positive predictive value for homeless shelter entry in the 6 months after an ED visit 21 . Screening for drug and unhealthy alcohol use employed validated single‐item screening questions capturing any drug use (including cannabis or prescription medications used for reasons other than prescribed) or binge drinking in the past year 22–24 …”

Section: Methodsmentioning

confidence: 99%

“…To our knowledge, however, no prior research has examined interventions to prevent homelessness among ED patients. We conducted a pilot feasibility study of an intervention delivered to ED patients with drug or unhealthy alcohol use who were identified as being at risk for future homelessness 21 . In this paper we describe the intervention, pilot feasibility study results, and implications for future research.…”

Section: Introductionmentioning

confidence: 99%

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ED‐Home: Pilot feasibility study of a targeted homelessness prevention intervention for emergency department patients with drug or unhealthy alcohol use

Fazio

Zuiderveen²,

Guyet³

et al. 2022

Academic Emergency Medicine

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Background: Housing insecurity is prevalent among emergency department (ED) patients. Despite a surge of interest in screening for patients' social needs including housing insecurity, little research has examined ED social needs interventions. We worked together with government and community partners to develop and pilot test a homelessness prevention intervention targeted to ED patients with drug or unhealthy alcohol use. Methods: We approached randomly sampled patients at an urban public hospital ED, May to August 2019. Adult patients were eligible if they were medically stable, not incarcerated, spoke English, had unhealthy alcohol or any drug use, and were not currently homeless but screened positive for risk of future homelessness using a previously developed risk screening tool. Participants received a three-part intervention: (1) brief counseling and referral to treatment for substance use delivered through a preexisting ED program; (2) referral to Homebase, an evidence-based community homelessness prevention program; and (3) up to three troubleshooting phone calls by study staff. Participants completed surveys at baseline and 6 months. Results: Of 2183 patients screened, 51 were eligible and 40 (78.4%) participated; one later withdrew, leaving 39 participants. Participants were diverse in age, gender, race, and ethnicity. Of the 32 participants reached at 6 months, most said it was very or extremely helpful to talk to someone about their housing situation (n = 23, 71.9%) at the baseline ED visit. Thirteen (40.6%) said their housing situation had improved in the past 6 months and 16 (50.0%) said it had not changed. Twenty participants (62.5%) had made contact with a Homebase office. Participants shared ideas of how to improve the intervention.

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Characteristics and Health Care Utilization of Patients With Housing Insecurity in the ED

Ball,

Sack,

Druffner

et al. 2024

JAMA Netw Open

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ImportanceUnstable housing and homelessness can exacerbate adverse health outcomes leading to increased risk of chronic disease, injury, and disability. However, emergency departments (EDs) have no universal method to identify those at risk of or currently experiencing homelessness.ObjectiveTo describe the extent of housing insecurity among patients who seek care in an urban ED, including chief concerns, demographics, and patterns of health care utilization.Design, Setting, and ParticipantsThis cross-sectional study included all adult patients presenting to the ED at Vanderbilt University Medical Center (VUMC), an urban tertiary care, level I trauma center in the Southeast US, from January 5 to May 16, 2023.Main Outcomes and MeasuresThe primary outcome was the proportion of ED visits at which patients screened positive for housing insecurity. Secondary outcomes included prevalence of insecurity by chief concerns, demographics, and patterns of health care utilization.ResultsOf all 23 795 VUMC ED visits with screenings for housing insecurity (12 465 visits among women [52%]; median age, 47 years [IQR, 32-48 years]), in 1185 (5%), patients screened positive for current homelessness or housing insecurity (660 unique patients); at 22 610 visits (95%), the screening result was negative. Of visits with positive results, the median age of patients was 46 years (IQR, 36-55 years) and 829 (70%) were among male patients. Suicide and intoxication were more common chief concerns among visits at which patients screened positive (132 [11%] and 118 [10%], respectively) than among those at which patients screened negative (220 [1%] and 335 [2%], respectively). Visits with positive results were more likely to be among patients who were uninsured (395 [33%] vs 2272 [10%]) and had multiple visits during the study period. A higher proportion of positive screening results occurred between 8 pm and 6 am. The social work team assessed patients at 919 visits (78%) with positive screening results.Conclusions and RelevanceIn this cross-sectional study of 23 795 ED visits, at 5% of visits, patients screened positive for housing insecurity and were more likely to present with a chief concern of suicide, to be uninsured, and to have multiple visits during the study period. This analysis provides a call for other institutions to introduce screening and create tailored care plans for patients experiencing housing insecurity to achieve equitable health care.

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Development of a homelessness risk screening tool for emergency department patients

Cited by 12 publications

References 24 publications

Performance of 2 Single-Item Screening Questions to Identify Future Homelessness Among Emergency Department Patients

Performance of 2 Single-Item Screening Questions to Identify Future Homelessness Among Emergency Department Patients

ED‐Home: Pilot feasibility study of a targeted homelessness prevention intervention for emergency department patients with drug or unhealthy alcohol use

Characteristics and Health Care Utilization of Patients With Housing Insecurity in the ED

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