BACKGROUND: The American Academy of Pediatrics and the Academic Pediatric Association have published guidelines supporting screening and referral for social determinants of health (SDH) in pediatric primary care. Despite this charge, little is known about the current prevalence of screening practices taking place in medical homes across the country.OBJECTIVE: The objective of this study is to describe current practices for systematically screening for social determinants of health in nationwide pediatric continuity clinics enrolled in the CORNET network.
METHODS: We recruited 144 pediatric resident continuity clinics enrolled in the ContinuityResearch Network (CORNET) of the Academic Pediatric Association. Continuity clinic directors at 75 sites agreeing to participate received an electronic survey instrument requesting clinic demographics and information on screening and educational practices for fifteen social determinants of health.
RESULTS:In the sixty-four clinic sites that responded to the survey, the range of SDH being screened for was 0-15 with a mean of 7. The most commonly screened SDH were maternal depression (86%), child education (84%), food insecurity (71%) and firearm exposure (65%).Most commonly, screening instruments are paper documents original to the clinic. Primary iii providers, nurses or medical assistants administer the majority of screens on rooming or during the encounter. Clinics not currently screening have plans to begin screening for nearly a quarter of those SDH not currently being screened within the next 3 years. Clinic directors most often cited lack of time (63%), lack of resources to address positive screen (50%) and inadequate training (46%) as barriers to SDH screening. Less than 10% of resident continuity clinic directors cited lack of indication or evidence for screening as barriers. CONCLUSIONS: Screening for SDH in pediatric resident continuity clinics has not yet been universally implemented. Screening practices are variable reflecting the complex nature of screening and the heterogeneity of the various SDH. Characteristics of commonly screened SDH include validated, concise screening tools, longstanding Bright Futures recommendations, literature suggesting benefit, and identifiable interventions. The major barriers to SDH screening are lack of time and lack of resources to address positive screens. A variety of measures including comprehensive, concise screening tools, up-to-date community resource guides, streamlined referral processes, embedded multidisciplinary teams, and strong community partnerships could mitigate these barriers.