How can a pregnant individual with cerebral palsy (CP) and current housing insecurity be prioritized for stable housing to minimize health risks?

Housing Advocacy Letter for Pregnant Individual with Cerebral Palsy

A pregnant individual with cerebral palsy experiencing housing insecurity should be prioritized for immediate stable housing placement, as housing instability during pregnancy significantly increases risks of preterm birth, low birth weight, and maternal morbidity—risks already elevated by cerebral palsy itself.

Medical Justification for Priority Housing Placement

Compounded High-Risk Pregnancy Status

This patient faces dual high-risk factors that independently and synergistically increase maternal and fetal morbidity:

• Cerebral palsy in pregnancy is associated with significantly elevated rates of cesarean delivery (50.4%), preterm birth (12.1%), low birth weight infants (15.7%), and very low birth weight infants (7.1%)—all substantially higher than national averages 1
• Housing insecurity during pregnancy directly contributes to adverse pregnancy and infant outcomes from birth through early childhood, with documented impacts on maternal and child health 2
• Women with CP commonly experience loss of mobility during pregnancy, requiring specialized physical and occupational therapy services that are difficult to access without stable housing 1

Life-Threatening Nature of Combined Risk Factors

Housing instability creates barriers to accessing essential prenatal care and managing the complex medical needs associated with cerebral palsy during pregnancy:

• Housing insecurity is recognized as a critical contributor to maternal morbidity and mortality, particularly for women with pre-existing medical conditions 3
• Lack of stable housing prevents consistent prenatal care attendance, medication adherence, and timely intervention for pregnancy complications 3
• The combination of physical disability and housing instability creates compounding barriers to healthcare access that directly threaten maternal and fetal survival 3

Addressing Current Housing Prioritization System Limitations

Medical Complexity Not Adequately Captured

Current Coordinated Entry systems often fail to appropriately prioritize individuals with severe medical conditions like cerebral palsy:

• Existing prioritization algorithms disadvantage people with the most severe or complex medical conditions by counting the number of problems rather than severity within a single domain 3
• Many systems fail to distinguish between physical ailments and major medical needs, such as requiring specialized pregnancy care for someone with a disabling neurological condition 3
• Housing prioritization systems should account for and raise the priority of specific medical conditions or healthcare needs, as permitted under the Fair Housing Act 3

Pregnancy as Acute Medical Need

The time-sensitive nature of pregnancy creates an urgent medical need that standard housing waitlists cannot accommodate:

• Pregnancy represents a finite window during which housing instability causes irreversible harm to both mother and developing fetus 2
• Timely and meaningful access to safe and stable housing during pregnancy is essential to prevent adverse outcomes 2
• Dialysis providers and clinicians managing organ- or life-limiting diseases should identify clients who require housing to acutely prevent death associated with homelessness exposure 3—this principle applies equally to high-risk pregnancy with disability

Specific Recommendations for Housing Authority

Immediate Priority Placement Justification

This patient meets criteria for emergency housing prioritization based on:

1. Documented disability (cerebral palsy) that substantially limits major life activities and increases pregnancy complications 3, 1
2. Acute medical vulnerability during pregnancy requiring stable environment for prenatal care, therapy services, and complication management 1, 2
3. Time-sensitive medical need where delays in housing placement directly correlate with irreversible maternal and fetal harm 2
4. Inability to safely manage pregnancy complications without stable housing for medication storage, therapy equipment, and consistent healthcare access 1

Required Housing Accommodations

Stable housing must provide:

• Accessible features accommodating mobility limitations that worsen during pregnancy in women with CP 1
• Space for medical equipment and supplies needed for pregnancy monitoring and potential home-based therapies 3
• Proximity to healthcare facilities for frequent prenatal visits and emergency obstetric care 2
• Safe environment supporting postpartum recovery and infant care given physical limitations 1

Care Coordination Requirements

Housing placement should be coordinated with:

• Referrals to physical and occupational therapy to address pregnancy-related mobility loss in CP 1
• Connection to prenatal care providers experienced in high-risk pregnancy management 3
• Postpartum depression screening and mental health support services 1
• Community health workers or care navigators to facilitate medical service navigation and address ongoing social needs 3

Advocacy for System-Level Change

Beyond this individual case, the nephrology and maternal-fetal medicine communities recommend:

• Restructuring local Coordinated Entry systems to account for medical severity and life-threatening conditions 3
• Introducing screening questions to identify clients requiring housing to prevent death associated with homelessness exposure 3
• Prioritizing individuals who require stabilization to successfully access and benefit from life-saving medical interventions 3
• Extending Medicaid coverage to 12 months postpartum to support ongoing medical and housing needs 3

Housing is not merely a social determinant but a medical necessity for this patient—stable housing is the intervention that enables all other medical care to be effective and prevents irreversible harm to both mother and child.