Co-developing SHELTER (Safe, Healthy Environments and Local Transformation for Equity and Resilience) with families with lived experience of homelessness in the New York City shelter system: A community needs assessment and data collection protocol.

Over 120,000 people were staying in New York City shelters nightly as of January 2025, including more than 41,000 children.

• The nightly census in January 2025 revealed over 120,000 people in NYC shelters.
• More than 41,000 of those shelter residents were children.
• Almost half of those children were aged 0-5 years.

Children under five years old experiencing homelessness are especially vulnerable due to the critical nature of early childhood for brain development.

• The first five years of life are described as a critical period for child growth.
• Approximately 90% of brain development occurs within the first five years of life.
• Under-5s experiencing homelessness have a higher risk for multiple adverse childhood experiences.
• This population also faces elevated risk for developing chronic health conditions and recurrent homelessness across the life course.

Data available for children under five experiencing homelessness in the United States is generally lacking and of notably poor quality.

• The authors describe a 'wide evidence gap' in the available data for this population.
• Existing data is characterized as being of 'notably poor quality in the United States.'
• This gap leaves an inability to determine the actual needs of this population.

The SHELTER protocol was co-developed with families with under-5s who have lived experience of homelessness in NYC shelters using community-based participatory research.

• The study employs community-based participatory research (CBPR) methodology.
• Co-development involved families with children under five who have lived experience of homelessness in NYC shelters.
• The aim is to determine what barriers exist in the physical and social environments to optimizing health and wellbeing among under-5s living in NYC shelters.
• Health and wellbeing outcomes of interest include milestones, child mental health, parental mental health, and safety.

The proposed study uses a sequential mixed-methods design comprising a quantitative survey and qualitative semi-structured interviews as an assets- and deficits-based health needs assessment.

• The design is described as a 'sequential mixed-methods design.'
• Data collection includes both a quantitative survey and qualitative semi-structured interviews.
• The needs assessment is framed as both assets-based and deficits-based.
• The long-term objective is to enhance the quality and quantity of data for this vulnerable population to lay the groundwork for future co-development of a comprehensive intervention.