Multiple Behavior Change Intervention to Improve Detection of Unmet Social Needs and Resulting Resource Referrals

Abstract

Objective It is critical that pediatric residents learn to effectively screen families for active and addressable social needs (i.e., negative social determinants of health.) We sought to determine 1) whether a brief intervention teaching residents about IHELP, a social needs screening tool, could improve resident screening, and 2) how accurately IHELP could detect needs in the inpatient setting. Methods During an 18-month period, interns rotating on one of two otherwise identical inpatient general pediatrics teams were trained in IHELP. Interns on the other team served as the comparison group. Every admission history and physical (H&P) was reviewed for IHELP screening. Social work evaluations were used to establish the sensitivity and specificity of IHELP and document resources provided to families with active needs. During a 21-month post-intervention period, every third H&P was reviewed to determine median duration of continued IHELP use. Results 619 admissions met inclusion criteria. Over 80% of intervention team H&Ps documented use of IHELP. The percentage of social work consults was nearly 3 times greater on the intervention team than on the comparison team (P<0.001). Among H&Ps with documented use of IHELP, specificity was 0.96 (95% CI 0.87–0.99) and sensitivity was 0.63 (95% CI 0.50–0.73). Social work provided resources for 78% of positively screened families. The median duration of screening use by residents after the intervention was 8.1 months (IQR 1–10 months) Conclusions A brief intervention increased resident screening and detection of social needs, leading to important referrals to address those needs.

Screening Children for Social Determinants of Health: A Systematic Review

“…Two screeners included additional information reported by a social worker 16 or physician. 20 Screeners were completed via a variety of methods, including paper and pencil, 11,[17][18][19][20][23][24][25][26]30 computer or tablet, [17][18][19]22,26,27 faceto-face interview, 12,16,21,[27][28][29] and phone interview. 12,27 All screeners were available in English, with 7 screeners also available in Spanish.…”

“…11,12,[17][18][19][20][22][23][24][25][26][27]30 Three screeners had validity and/or reliability assessed in $1 study. 18,24,29 With respect to the time frame that respondents were asked to reflect on when answering questions about SDOHs, the majority of screeners (ie, 6 screeners) did not have a clearly defined referent period (eg, past 30 days, past year, or lifetime); the referent periods for other screeners varied by question, 18,22,28 and only 2 screeners had a single, clearly defined referent period for all included questions. 16,24 Regarding how the SDOH screeners were developed, only 4 screeners reported being informed by practice 18,21,24 and/or expert opinion.…”

“…newly created family context domain because this SDOH occurs within the family unit. Common areas examined under the economic stability domain included food insufficiency, 11,12,[16][17][18][19][21][22][23][24][25][26][27][28][29][30] housing instability, 11,12,16,[22][23][24][25][27][28][29][30] and difficulty paying bills, making ends meet, or meeting basic needs. 11,12,[21][22][23][24][25]27,28,30 Seven screeners assessed the education domain, which included questions assessing parental education 11,20,[23][24][25]28,30 and access to child care.…”

“…11,12,[21][22][23][24][25]27,28,30 Seven screeners assessed the education domain, which included questions assessing parental education 11,20,[23][24][25]28,30 and access to child care. 11,12,[23][24][25]27,30 Six screeners assessed the health and health care domain, with parent and child health insurance status 12,22,25,27,29 being the most common area examined. Seven screeners assessed the neighborhood and built environment, 12,[21][22][23]25,[27][28][29] with concerns about the physical conditions of housing being the most common inquiry, 12,21,22,25,[27][28][29] followed by violence and safety.…”

Nurses and the Social Determinants of Health

“…Second, every health care encounter is an opportunity to assess adverse childhood experiences and overall adversity the child and family has or is experiencing. Tools such as the SEEK Parent Screening Questionnaire (PSQ3) A Safe Environment for Every Kid (SEEK Parent Screening Questionnaire [PSQ3], ) and the IHELP Social History Method (Colvin et al., ) are evidence‐informed clinical tools that can guide the discussion of these sensitive topics. However, it is imperative that if these questions are asked, resources to address identified concerns are available onsite or by community referrals.…”