Effects of In-Person Navigation to Address Family Social Needs on Child Health Care Utilization

Abstract

IMPORTANCE While many organizations endorse screening for social risk factors in clinical settings, few studies have examined the health and utilization effects of interventions to address social needs. OBJECTIVE To compare the acute care utilization effects of a written resources handout vs an in-person navigation service intervention to address social needs. DESIGN, SETTINGS, AND PARTICIPANTS In this secondary analysis of a randomized clinical trial, 1809 adult caregivers of pediatric patients seen in primary and urgent care clinics of 2 safety-net hospitals in northern California were recruited between October 13, 2013, and August 27, 2015. Each participating family was randomly assigned to an in-person navigator intervention vs active control to address the family's social needs. Analyses were conducted between February 28, 2018, and September 25, 2019. INTERVENTIONS Caregivers either received written information about relevant local resources related to social needs (active control) or met with a patient navigator focused on helping them resolve social needs (navigator intervention). After an initial in-person visit, navigation services included telephone, email, and/or in-person follow-up for up to 3 months. MAIN OUTCOME AND MEASURES Child emergency department visit or hospitalization within 12 months of study enrollment. RESULTS Among the 1300 caregivers enrolled in the study without missing follow-up data, most spoke English (878 [67.5%]) and were women (1127 [86.7%]), with a mean (SD) age of 33.0 (9.33) years. Most children were aged 0 to 5 years (779 of 1300 [59.9%]), 723 children (55.6%) had Hispanic ethnicity, and 462 children (35.5%) were in excellent health; 840 families (64.6%) were recruited from urgent care. In total, 637 families (49.0%) were randomized to the in-person navigator group and 663 (51.0%) to the active control group. There was no difference in risk of an emergency department visit between the 2 groups. Children enrolled in the in-person navigator group had a decreased risk of hospitalization within 12 months (hazard ratio, 0.59; 05% CI, 0.38-0.94; P = .03), making them 69% less likely to be hospitalized. CONCLUSIONS AND RELEVANCE In this randomized clinical trial evaluating heath care utilization effects of programs designed to address social needs among families, children enrolled in the navigation group were significantly less likely to be hospitalized after the intervention but equally likely to have an emergency department visit. These findings strengthen our understanding of the (continued) Key Points Question Can an in-person service navigation intervention to address family social needs decrease child health care utilization? Findings In this randomized clinical trial of 1300 families, provision of an in-person resource navigator significantly decreased the risk of child hospitalization during a 1-year period compared with written information. Meaning These findings suggest that providing a patient navigator to address family social needs can decrease child health care utiliz...

Workforce Models to Screen for and Address Patients’ Unmet Social Needs in the Clinic Setting: A Scoping Review

“…To describe the structure of workforce models performing these activities, studies were first sorted by mode of administration used for screening. We found 37 studies used self-administered screening with patients, 29,30,32,34,41,42-46,48,52-54,56,59,61,62,64-66, 68,69,71-73,75-77,79,80-84,86,87 24 studies used clinician-administered screening, [26][27][28]31,33,[35][36][37][38][39][40]47,[49][50][51]57,60,63,74,78,85,[88][89][90] 3 studies used both, 55,58,70 and 1 study did not mention the mode screening administration 67 (Figure 2). We then categorized the workforce associated with each screening administration type and the roles who responded to identified needs.…”

“…The remainder reported using observational study designs (eg, pre-post studies, feasibility studies, pilot studies). Fifty-eight studies were conducted with primary care patients, [29][30][31][72][73][74]76,[78][79][80][81][82][83][84][85][86][87][88][89] 4 took place in a specialty clinics, 32,71,75,77 1 took place in urgent care, 27 and 3 took place across multiple settings (eg, primary, specialty, and urgent care). 26,28,90 Majority of studies reported including academic sites (n = 40), 29,[34][35][36][37][38][39][41][42][43][44][47][48][49][50][51][52][53][54][55][56]…”

“…26,28,90 Majority of studies reported including academic sites (n = 40), 29,[34][35][36][37][38][39][41][42][43][44][47][48][49][50][51][52][53][54][55][56][57][58][59]62,63,65,66,71,72,75,[77][78][79][80]82,84,85,89,90 including urban sites (n = 48), 26-30,32,34-56,61-63,65-68,71,72,75,77,79-81 ,83,87-90 and including the pediatric and adolescent population (n = 40). [26][27][28][29][30][35][36]…”

“…Of the 24 studies that included clinician-administered screening, 1 used medical providers to screen patients, 37 7 used medical residents, [35][36][37][38][39]89,90 1 used a combination of clinical and social care staff (eg, nurse, social worker, medical assistant), 40 and 15 used paid social care staff (eg, case managers, community health workers, navigators) or volunteers. [26][27][28]31,33,[49][50][51]57,60,63,74,78,85,88 In the 8 models using medical providers or residents, they either (1) assisted patients directly through community resource referrals, 38,39 (2) provided community resource referrals with an option to escalate to a social worker or an on-site medical legal partnership, 36,37,47,90 or (3) directly referred patients to social work or the onsite medical legal partnership without providing community resource information themselves. 35,89 In the 15 models that used social care staff or non-physician clinical staff to administer screenings, the same worker who conducted the screening was the same worker to provide initial assistance to patients, 31,36,40,41,44,55,56,58,61,…”

“…Three studies described using both selfadministered and clinician-administered screening. 55,58,70 For example, in 1 model, front desk staff provided paper 31 Safety-net urgent care clinic 27 Adults with depression 31 Community health center 30,31 Women with depression 32 Women's health clinic 32 Multi-setting 26,28 Difference-indifference/quasiexperimental Urban 34 Academic primary care clinic 34 Adults 34 Not mentioned 33 Integrated health system 33 Adults with predicted high utilization 33 Pre-post with control Urban [35][36][37] Academic primary care clinic 35- 60 Elderly Hispanic adults 57 Community health center/ federally qualified health center 40,45,46,61,68,69 Pregnant women 40 Black women 49,50 Women with depression 71 Academic-federally qualified health center 39,57,62,66 Multiple populations 45,55 Unspecified primary care clinic 64,67 Not mentioned 41,60,63 Multi-primary care setting 49,50,55,58 Quality improvem...…”