Youth experiencing homelessness (YEH) have high rates of both mental and physical health concerns, including a higher rate of sexual assault, pregnancy and STIs as compared to youth in the general population. YEH face multiple barriers in accessing care, resulting in reliance on Emergency Departments (ED). The use of the pediatric ED by YEH in Canada, including for sexual and reproductive (SRH) concerns, is not well described; additionally, there is no Canadian data exploring the effects of the COVID-19 pandemic/lockdown on ED presentations by this population. Study aims: 1) To review YEH pediatric ED presentation chief complaints (CC); 2) To compare data between pre and post COVID-19 pandemic timelines.

Electronic medical records (EMR) were retrospectively reviewed chart review design was used using the EMR was searched over a 45-month period (05/01/18 to 01/31/22) for any ED encounters for: 1) patients identifying youth shelter address as place of residence; 2) the terms “shelter”, “homeless”, “street-involved”, “street-youth”. Data was recorded into RedCap. Descriptive statistics were used, as well as comparative analysis of 2 time periods: 1) “pre-COVID” 05/01/18-03/15/20; 2) “post-COVID lockdown” 03/16/21-01/31/22. This study was approved by the REB.

A total of 1103 encounters (patient mean age 16.58 yrs) were included in analysis. Over the 45-month time period, CCs were evenly split between mental health concerns (n=562, 50.9%) and physical concerns (n=541, 49%). Patient SRH concerns represented 5% (n=58) of all encounters (see Figure 1). When comparing timelines, there were significantly fewer presentations in the months “post COVID-lockdown” (n=465) as compared to “pre-COVID” (n=638). There was a significant reduction in mental health related CCs, with no significant change in physical related CCs including SRH related concerns (Table 1).

YEH utilize the pediatric ED for both their mental and physical healthcare, including concerns related to SRH. Lower attendance to the pediatric ED for mental health related concerns following the pandemic lockdown, while physical health encounters remained steady, may reflect increased barriers to care and/or novel methods of mental health care delivery post-pandemic. The results of this study will inform the creation of an outpatient outreach program to better meet the needs of this population, when possible, outside of the pediatric ED.