Impact of a Community Health Worker Program to Support Caregivers of Children With Special Health Care Needs and Address Social Determinants of Health

Abstract

Few studies have evaluated the effects of a community health worker (CHW) intervention on social determinants and caregiver distress. This study assesses the impact of a CHW program for caregivers of children with special health care needs (CSHCN) on these factors in addition to confidence in self-management. A retrospective, pre-post analysis was conducted for those who completed a CHW program. Caregivers reported high levels of distress, low educational attainment, linguistic isolation, positive depression screens, and food and housing issues at baseline. On completion of the program, there was significant improvement in caregiver distress scores ( P < .001) and in understanding of their children’s diagnoses ( P < .001). Furthermore, the number of caregivers reporting food or housing issues was significantly reduced ( P < .01 and P < .01, respectively). This study demonstrates the feasibility and potential effects of a CHW intervention for CSHCN and highlights the need for a large-scale controlled trial to further evaluate impact.

Screening and social prescribing in healthcare and social services to address housing issues among children and families: a systematic review

“…Studies were heterogenous in terms of method, design, sample size, age of participants, social screening tools and housing questions included in screening tools. Study types varied; cross-sectional,30 47 57 65–79 randomised controlled trials,43 44 80–84 pre and post studies,85–88 prospective,89 90 QI,59 91–96 mixed methods,97 98 tool adaptation and validation,99 retrospective100–102 and secondary data analysis 103. Sample sizes ranged from 45 to 56 253 participants.…”

“…A common issue related to the representative sample of the target population, with the sample size not being representative in 7 of the 29 studies, and another 5 studies providing insufficient information to assess whether the sample size was representative. The risk of non-response bias was low in 16 of the quantitative descriptive studies 30 73 75 76 79 82 86–89 99 104–106. The two mixed methods studies were of good quality however both did not adequately address inconsistencies between quantitative and qualitative results and did not adhere to the tradition of each method 97 98.…”

“…Housing instability, insecurity or homelessness were the most common housing-related screening questions across the studies, with questions about homelessness, risk of homelessness, sleeping in a shelter, sleeping outside or in a place not meant for sleeping, sleeping in unsafe housing, frequent moving and temporary or unsafe housing 30 43 44 57 65 67 68 71–80 82–84 86–90 92–97 101 102 105 107. Utilities as an unmet need, especially in relation to home heating, were included as a common housing issue captured in the social screening tools of studies in this review.…”

“…Twenty-seven studies reported provision of information, and/or social prescribing, that is, a linking or referral occurred after identifying a social need as part of screening. Several studies provided patients with a community resource guide, a list of local housing services, community resource information or clinic-based resources43 44 57 59 70–73 75 78 84 87–89 92–95 after screening for housing and other social needs. Social prescribing was also common, with patients screening positively being referred to a social worker, care coordinator, care navigation service, community health worker or advocate,59 67 75 83 84 86 88 90 95 96 101 102 107 social service agency or community organisation,87 96 103 referral to a housing and child welfare demonstration project97 or provided intensive case management in the form of wraparound services relating directly to a family’s specific needs 84.…”

Research Agenda for Implementation of Principles of Care for Children and Youth With Special Health Care Needs

“…20 Research gaps include lack of knowledge of how care expectations extend to community-based roles and the necessary training to sustain these roles. As an example, community-based health workers may be important partners in the care of CYSHCN to address social determinants of health, 31,32 with opportunities to address how such team members may be deployed to address a broad range of diagnoses and settings. Finally, additional knowledge gaps exist about how to train such care teams and assure bidirectional communication between team members.…”