Cross-Sector Approach Expands Screening and Addresses Health-Related Social Needs in Primary Care

Abstract

OBJECTIVES During infancy, the American Academy of Pediatrics Bright Futures fourth edition health supervision guidelines recommend frequent well-child visits (WCVs) in which providers are expected to screen for and address maternal depression, intimate partner violence (IPV), and health-related social needs (HRSN). We spread an evidence-based approach that implements these recommendations (Developmental Understanding and Legal Collaboration for Everyone; DULCE) with 3 aims for 6-month-old infants and their families: 75% receive all WCVs on time, 95% are screened for 7 HRSNs, and 90% of families with concrete supports needs and 75% of families with maternal depression or IPV receive support. METHODS Between January 2017 and July 2018, five DULCE teams (including a community health worker, early childhood system representative, legal partner, clinic administrator, pediatric and behavioral health clinicians) from 3 communities in 2 states participated in a learning collaborative. Teams adapted DULCE using Plan-Do-Study-Act cycles, reported data, and shared learning monthly. Run charts were used to study measures. The main outcome was the percent of infants that received all WCVs on time. RESULTS The percentage of families who completed all WCVs on time increased from 46% to 65%. More than 95% of families were screened for HRSNs, 70% had ≥1 positive screen, and 86% and 71% of those received resource information for concrete supports and maternal depression and IPV, respectively. CONCLUSIONS Quality improvement–supported DULCE expansion increased by 50% the proportion of infants receiving all WCVs on time and reliably identified and addressed families’ HRSNs, via integration of existing resources.

Screening and social prescribing in healthcare and social services to address housing issues among children and families: a systematic review

“…There were seven QI studies, assessed using the QI-MQCS. Five of the seven studies scored highly, scoring well in 10 of the 15 criteria 59 91 94–96. Issues with QI studies included adherence, reporting data on health-related outcomes, organisational readiness and spread.…”

“…Studies were heterogenous in terms of method, design, sample size, age of participants, social screening tools and housing questions included in screening tools. Study types varied; cross-sectional,30 47 57 65–79 randomised controlled trials,43 44 80–84 pre and post studies,85–88 prospective,89 90 QI,59 91–96 mixed methods,97 98 tool adaptation and validation,99 retrospective100–102 and secondary data analysis 103. Sample sizes ranged from 45 to 56 253 participants.…”

“…Housing instability, insecurity or homelessness were the most common housing-related screening questions across the studies, with questions about homelessness, risk of homelessness, sleeping in a shelter, sleeping outside or in a place not meant for sleeping, sleeping in unsafe housing, frequent moving and temporary or unsafe housing 30 43 44 57 65 67 68 71–80 82–84 86–90 92–97 101 102 105 107. Utilities as an unmet need, especially in relation to home heating, were included as a common housing issue captured in the social screening tools of studies in this review.…”

“…Fourteen (n=14) screening tools had been validated, including the Family Wellness Screening tool,103 Well Child Care, Evaluation, Community Resources, Advocacy, Referral, Education (WE CARE) tool,66 The Online Advocate,47 The Protocol for Responding to and Assessing Patients’ Assets, Risks and Experiences (PRAPARE) tool,108 The Health Leads Screening Toolkit109 as well as other tools used across studies 43 66 77 80 94 98 99 108. The studies included in this review did not provide detailed information on validity.…”

“…Twenty-five papers (n=25) in this review provided the exact wording of housing questions used in their studies, while some studies only provided prompts rather than the exact questions, for example, ‘home heating’, 43 ‘residential mobility’, 82 ‘concerns about the physical condition of your housing’ 80 or ‘unhealthy housing’. 94 In the latter examples it was not clear how the questions were asked, for example, whether healthcare and social service staff asked questions word-for-word, or used the screening tool questions as prompts or as a guide. Some studies reported the name of the screening tool they used, but did not list the questions.…”