Identification of Caregiver-Reported Social Risk Factors in Hospitalized Children

Abstract

Although health systems are increasingly moving toward addressing social determinants of health, social risk screening for hospitalized children is largely unexplored. We sought to determine if inpatient screening was feasible and describe the prevalence of social risk among children and caregivers, with special attention given to children with chronic conditions. METHODS: Caregivers of pediatric patients on the hospitalist service at a children's hospital in the Pacific Northwest completed a social risk survey in 2017. This survey was used to capture items related to caregiver demographics; socioeconomic, psychosocial, and household risks; and adverse childhood experiences (ACEs). Charts were reviewed for child demographics and medical complexity. Results were tabulated as frequency distributions, and analyses compared the association of risk factors with a child's medical complexity by using x 2 tests. RESULTS: A total of 265 out of 304 (87%) caregivers consented to participate. One in 3 families endorsed markers of financial stress (eg, difficulty paying for food, rent, or utilities). Forty percent experienced medical bill or insurance troubles. Caregiver mental health concerns were prevalent, affecting over one-third of all respondents. ACEs were also common, with 38% of children having at least 1 ACE. The presence of any ACE was more likely for children with chronic conditions than those without. CONCLUSIONS: We found that social risk screening in the inpatient setting was feasible; social risk was uniformly common and did not disproportionately affect those with chronic diseases. Knowing the prevalence of social risk may assist in appropriate alignment of interventions tiered by social complexity.

Nonresponse to Health-Related Social Needs Screening Questions

“…By recruiting caregivers of children presenting for nonurgent ED care, we focused on a population anticipated to have high social needs. Our sample reported social needs similar to other recent samples of children in primary care, emergency care, or hospital settings 31,49 but lower than others. 30,32 Surveys were completed "There was a lot of information, maybe having one sheet that is most useful."…”

A pilot mixed‐methods randomized controlled trial of verbal versus electronic screening for adverse social determinants of health

“…14 The majority of research to date on screening strategies for identifying aSDoH has been conducted in primary care settings. [15][16][17] The optimal strategy for aSDoH screening in the ED is not yet known, as some studies have shown that electronic strategies may be superior, 18,19 but concerns remain about whether disparities in health and digital literacy may limit the applicability of that strategy within the ED.…”

The terminology of social emergency medicine: Measuring social determinants of health, social risk, and social need

“…7 In addition, different programs have used different terms for similar concepts including SDoH, 2,20,23 health-related social needs, 5,24 social needs, 25,26 and social risk. [27][28][29] ED clinicians, researchers, and policy makers, need a consistent terminology to identify patients who screen positive and those who are requesting assistance. In addition, an appropriate terminology would allow clinicians and researchers to have increased clarity about the goals of individual screening programs (eg, service, epidemiology, risk stratification), allow for improved comparison across studies, and allow policy makers and researchers to more effectively communicate and therefore more rapidly disseminate research.…”

“…Implementation of ED screening is complicated by the heterogeneity of screening tools and the lack of a goldstandard to identify SDoH 7 . In addition, different programs have used different terms for similar concepts including SDoH, 2,20,23 health‐related social needs, 5,24 social needs, 25,26 and social risk 27‐29 . ED clinicians, researchers, and policy makers, need a consistent terminology to identify patients who screen positive and those who are requesting assistance.…”