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.

Social determinants of health screening in pediatric healthcare settings

“…A review by Gottlieb et al [68] identified 37 programs aimed at addressing family social and economic needs, but these evaluations were largely focused on process measures like referral rate and effect on social determinants of health rather than health outcomes, utilization, or cost [69]. For example, whereas screening for health-harming legal needs and referral to medical–legal partnerships has been associated with positive legal outcomes and improvements in social determinants of health, studies linking this process to decreased acute healthcare utilization and health outcomes are limited [70 ▪ ,71,72 ▪ ]. Although larger scale intervention studies are underway, a standardized approach to evaluation, particularly in pediatrics, is still lacking [73].…”