Families' Health-Related Social Problems and Missed Referral Opportunities

Fleegler, Eric W.; Lieu, Tracy A.; Wise, Paul H.; Muret-Wagstaff, Sharon

doi:10.1542/peds.2006-1505

Cited by 140 publications

(167 citation statements)

References 28 publications

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“…29 These all point to the need for systematic comprehensive social screening in pediatric health care settings. 30 Rates of such screening are low, even in settings serving lowincome populations where social adversities are more prevalent. [30][31][32] Informal social screening is inadequate: providers routinely underestimate social needs in most areas except drug and alcohol use, 33 and standardized screening has been shown to be more sensitive than provider clinical interviews.…”

Section: Discussionmentioning

confidence: 99%

“…30 Rates of such screening are low, even in settings serving lowincome populations where social adversities are more prevalent. [30][31][32] Informal social screening is inadequate: providers routinely underestimate social needs in most areas except drug and alcohol use, 33 and standardized screening has been shown to be more sensitive than provider clinical interviews. 34 One obstacle to social and economic needs screening is potential patient discomfort in reporting what may be sensitive or stigmatized conditions.…”

Section: Discussionmentioning

confidence: 99%

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A Randomized Trial on Screening for Social Determinants of Health: the iScreen Study

Gottlieb¹,

Hessler²,

et al. 2014

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BACKGROUND: There is growing interest in clinical screening for pediatric social determinants of health, but little evidence on formats that maximize disclosure rates on a wide range of potentially sensitive topics. We designed a study to examine disclosure rates and hypothesized that there would be no difference in disclosure rates on face-to-face versus electronic screening formats for items other than highly sensitive items. METHODS: We conducted a randomized trial of electronic versus face-to-face social screening formats in a pediatric emergency department. Consenting English-speaking and Spanish-speaking adult caregivers familiar with the presenting child’s household were randomized to social screening via tablet computer (with option for audio assist) versus a face-to-face interview conducted by a fully bilingual/bicultural researcher. RESULTS: Almost all caregivers (96.8%) reported at least 1 social need, but rates of reporting on the more sensitive issues (household violence and substance abuse) were significantly higher in electronic format, and disclosure was marginally higher in electronic format for financial insecurity and neighborhood and school safety. There was a significant difference in the proportion of social needs items with higher endorsement in the computer-based group (70%) than the face-to-face group (30%). CONCLUSIONS: Pediatric clinical sites interested in incorporating caregiver-reported socioeconomic, environmental, and behavioral needs screening should consider electronic screening when feasible, particularly when assessing sensitive topics such as child safety and household member substance use.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Randomized Trial on Screening for Social Determinants of Health: the iScreen Study

Gottlieb¹,

Hessler²,

et al. 2014

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“…In lieu of having an on-site care navigator or social worker, practices might consider compiling or identifying a list of community resources to have available; doing so could allow for quick and targeted interventions during the child's appointment. 59 To develop or identify such a list, practices may work with a family advisory group to identify the most pertinent needs and resources. Alternatively, practices can turn to their local AAP chapter, health plans, hospitals, or nonprofit organizations that may already have existing and updated lists.…”

Section: Compiling a Resource Directorymentioning

confidence: 99%

Determinants of Health and Pediatric Primary Care Practices

Beck

Tschudy²,

Coker

et al. 2016

Pediatrics

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More than 20% of children nationally live in poverty. Pediatric primary care practices are critical points-of-contact for these patients and their families. Practices must consider risks that are rooted in poverty as they determine how to best deliver family-centered care and move toward action on the social determinants of health. The Practice-Level Care Delivery Subgroup of the Academic Pediatric Association's Task Force on Poverty has developed a roadmap for pediatric providers and practices to use as they adopt clinical practice redesign strategies aimed at mitigating poverty's negative impact on child health and well-being. The present article describes how care structures and processes can be altered in ways that align with the needs of families living in poverty. Attention is paid to both facilitators of and barriers to successful redesign strategies. We also illustrate how such a roadmap can be adapted by practices depending on the degree of patient need and the availability of practice resources devoted to intervening on the social determinants of health. In addition, ways in which practices can advocate for families in their communities and nationally are identified. Finally, given the relative dearth of evidence for many poverty-focused interventions in primary care, areas that would benefit from more in-depth study are considered. Such a focus is especially relevant as practices consider how they can best help families mitigate the impact of povertyrelated risks in ways that promote long-term health and well-being for children.abstract

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“…Some pediatricians may direct families to programs that reduce the impact of poverty on child and maternal nutrition and health care, and connect parents with social services and community resources to address family needs related to poverty, such as housing, employment, and affordable child care. 58 Parent-reported screening tools for assessment and referral of povertyrelated concerns have been developed and tested for use in WCC, 60,61 but none have been widely adopted, and studies suggest that these social concerns are usually not elicited during WCC visits. A study of parents in 2 urban pediatric clinics found that, although 82% of families reported having at least 1 psychosocial family concern (eg, housing, food, income insecurity), nearly one-half also reported having at least 1 unmet referral need.…”

Section: Povertymentioning

confidence: 99%

“…A study of parents in 2 urban pediatric clinics found that, although 82% of families reported having at least 1 psychosocial family concern (eg, housing, food, income insecurity), nearly one-half also reported having at least 1 unmet referral need. 61 …”

Section: Povertymentioning

confidence: 99%

Does Well-Child Care Have a Future in Pediatrics?

2013

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The most common adult chronic diseases affect 1 in 3 adults and account for more than three-quarters of US health care spending. The major childhood drivers of adult disease are distinctly nonmedical: poverty, poor educational outcomes, unhealthy social and physical environments, and unhealthy lifestyle choices. Ideally, well-child care (WCC) would address these drivers and help create healthier adults with more productive lives and lower health care costs. For children without serious acute and chronic medical problems, however, traditional pediatric preventive services may be largely ineffective in addressing the outcomes that really matter; that is, improving lifelong health and reducing the burden of adult chronic disease. In this article, we examine what role WCC has in addressing the major childhood drivers of adult disease and consider various models for the future of WCC within pediatrics.

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Families' Health-Related Social Problems and Missed Referral Opportunities

Cited by 140 publications

References 28 publications

A Randomized Trial on Screening for Social Determinants of Health: the iScreen Study

A Randomized Trial on Screening for Social Determinants of Health: the iScreen Study

Determinants of Health and Pediatric Primary Care Practices

Does Well-Child Care Have a Future in Pediatrics?

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