Screening for Basic Social Needs at a Medical Home for Low-Income Children

Garg, Arvin; Butz, Arlene; Dworkin, Paul H.; Lewis, Rooti A.; Serwint, Janet R.

doi:10.1177/0009922808320602

Cited by 114 publications

(119 citation statements)

References 22 publications

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“…The majority of patients (80%-90%) live in poverty and face significant financial hardship, with 51% of parents unemployed and 20% at risk for becoming homeless. 34 Approximately 85% of clinic patients are enrolled in a Medicaid managed care organization (MCO) and 15% have private insurance. Most clinic patients reside in the surrounding neighborhood, with a very high estimated HIV prevalence of approximately 2.5%.…”

Section: Methodsmentioning

confidence: 99%

Mindfulness-Based Stress Reduction for Urban Youth

Sibinga¹,

Kerrigan

Stewart

et al. 2011

The Journal of Alternative and Complementary Medicine

164

124

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Objectives: The objectives of this study were to assess the general acceptability and to assess domains of potential effect of a mindfulness-based stress reduction (MBSR) program for human immunodeficiency virus (HIV)-infected and at-risk urban youth. Methods: Thirteen-to twenty-one-year-old youth were recruited from the pediatric primary care clinic of an urban tertiary care hospital to participate in 4 MBSR groups. Each MBSR group consisted of nine weekly sessions of MBSR instruction. This mixed-methods evaluation consisted of quantitative data-attendance, psychologic symptoms (Symptom Checklist 90-Revised), and quality of life (Child Health and Illness Profile-Adolescent Edition)-and qualitative data-in-depth individual interviews conducted in a convenience sample of participants until interview themes were saturated. Analysis involved comparison of pre-and postintervention surveys and content analysis of interviews. Results: Thirty-three (33) youth attended at least one MBSR session. Of the 33 who attended any sessions, 26 youth (79%) attended the majority of the MBSR sessions and were considered ''program completers.'' Among program completers, 11 were HIV-infected, 77% were female, all were African American, and the average age was 16.8 years. Quantitative data show that following the MBSR program, participants had a significant reduction in hostility ( p ¼ 0.02), general discomfort ( p ¼ 0.01), and emotional discomfort ( p ¼ 0.02). Qualitative data (n ¼ 10) show perceived improvements in interpersonal relationships (including less conflict), school achievement, physical health, and reduced stress. Conclusions: The data suggest that MBSR instruction for urban youth may have a positive effect in domains related to hostility, interpersonal relationships, school achievement, and physical health. However, because of the small sample size and lack of control group, it cannot be distinguished whether the changes observed are due to MBSR or to nonspecific group effects. Further controlled trials should include assessment of the MBSR program's efficacy in these domains.

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Section: Methodsmentioning

confidence: 99%

Mindfulness-Based Stress Reduction for Urban Youth

Sibinga¹,

Kerrigan

Stewart

et al. 2011

The Journal of Alternative and Complementary Medicine

164

124

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“…We decided to screen for these needs because of their high prevalence among urban families, 19,27 the public availability of community resources designed to address them, and previous research demonstrating the association of these needs with negative child outcomes. 23,[28][29][30][31][32][33][34] The WE CARE clinical screening instrument was adapted from a larger family psychosocial screening instrument with test-retest reliability of .92.…”

Section: Study Arms We Carementioning

confidence: 99%

Addressing Social Determinants of Health at Well Child Care Visits: A Cluster RCT

et al. 2015

Self Cite

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OBJECTIVE: To evaluate the effect of a clinic-based screening and referral system (Well Child Care, Evaluation, Community Resources, Advocacy, Referral, Education [WE CARE]) on families' receipt of community-based resources for unmet basic needs. METHODS:We conducted a cluster randomized controlled trial at 8 urban community health centers, recruiting mothers of healthy infants. In the 4 WE CARE clinics, mothers completed a self-report screening instrument that assessed needs for child care, education, employment, food security, household heat, and housing. Providers made referrals for families; staff provided requisite applications and telephoned referred mothers within 1 month. Families at the 4 control community health centers received the usual care. We analyzed the results with generalized mixed-effect models.RESULTS: Three hundred thirty-six mothers were enrolled in the study (168 per arm). The majority of families had household incomes ,$20 000 (57%), and 68% had $2 unmet basic needs. More WE CARE mothers received $1 referral at the index visit (70% vs 8%; adjusted odds ratio [aOR] = 29.6; 95% confidence interval [CI], 14.7-59.6). At the 12-month visit, more WE CARE mothers had enrolled in a new community resource (39% vs 24%; aOR = 2.1; 95% CI, 1.2-3.7). WE CARE mothers had greater odds of being employed (aOR = 44.4; 95% CI, 9.8-201.4). WE CARE children had greater odds of being in child care (aOR = 6.3; 95% CI, 1.5-26.0). WE CARE families had greater odds of receiving fuel assistance (aOR = 11.9; 95% CI, 1.7-82.9) and lower odds of being in a homeless shelter (aOR = 0.2; 95% CI, 0.1-0.9).CONCLUSIONS: Systematically screening and referring for social determinants during well child care can lead to the receipt of more community resources for families. WHAT'S KNOWN ON THIS SUBJECT:Although pediatric professional guidelines emphasize addressing a child' s social environment in the context of well child care, it remains unclear whether screening for unmet basic needs at visits increases low-income families' receipt of community-based resources. WHAT THIS STUDY ADDS:This study demonstrates that systematically screening and referring for social determinants of health during primary care can lead to the receipt of more community resources for families.

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“…20 Many low-income families experience risks at multiple levels of this Hierarchy, risks that can have an undeniable impact on health and development. [22][23][24] Families confront issues related to food and housing insecurity at the base of the Hierarchy, as well as issues related to unemployment and lack of parenting support higher up on the Hierarchy. As we began to develop community interventions to address PPCC families' needs, Maslow's Hierarchy helped our team prioritize the risks we needed to focus on first and map them to appropriate interventions to more effectively help children reach their full potential.…”

Section: Organize and Prioritize Risks By Using Maslow's Hierarchy Ofmentioning

confidence: 99%

“…Still, many expressed discomfort with screening because few knew how to respond when hardships were identified. 22,23 This led to the development of curricula that sought to improve knowledge of the SDH and community resources and enhance empathic social screening and risk identification. [41][42][43][44] Building knowledge and gaining buy-in from key frontline providers is especially important because most were not raised in families that faced the same poverty-related hardships as their patients.…”

Section: Provider Trainingmentioning

confidence: 99%

A Road Map to Address the Social Determinants of Health Through Community Collaboration

Henize¹,

Beck

Klein

et al. 2015

Pediatrics

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Economic, environmental, and psychosocial needs are common and wideranging among families cared for in primary care settings. Still, pediatric care delivery models are not set up to systematically address these fundamental risks to health. We offer a roadmap to help structure primary care approaches to these needs through the development of comprehensive and effective collaborations between the primary care setting and community partners. We use Maslow's Hierarchy of Needs as a well-recognized conceptual model to organize, prioritize, and determine appropriate interventions that can be adapted to both small and large practices. Specifically, collaborations with community organizations expert in addressing issues commonly encountered in primary care centers can be designed and executed in a phased manner: (1) build the case for action through a family-centered risk assessment, (2) organize and prioritize risks and interventions, (3) develop and sustain interventions, and (4) operationalize interventions in the clinical setting. This phased approach to collaboration also includes shared vision, codeveloped plans for implementation and evaluation, resource alignment, joint reflection and adaptation, and shared decisions regarding next steps. Training, electronic health record integration, refinement by using quality improvement methods, and innovative use of clinical space are important components that may be useful in a variety of clinical settings. Successful examples highlight how clinical-community partnerships can help to systematically address a hierarchy of needs for children and families. Pediatricians and community partners can collaborate to improve the well-being of at-risk children by leveraging their respective strengths and shared vision for healthy families.Pediatricians and primary care centers embrace the importance of identifying and acting on the economic, environmental, and psychosocial needs faced by their patients and families. Early recognition and action on these social determinants of health (SDH) are increasingly seen as critical, given their known impact on morbidity and mortality. [1][2][3] The related toxic stress model suggests that adverse childhood events often rooted in the SDH disrupt physiologic processes and cause such experiences to "get under the skin."This places children at risk for adverse health and developmental outcomes that can persist into adulthood. 4,5 Defining, identifying, and mitigating these toxic stressors could therefore promote childhood resilience, positive development, and health later in life.There are increasing calls to reshape pediatric care to better address the SDH. The American Academy of Pediatrics has outlined principles of patient-and family-centered care that include supporting and empowering children and families across the life

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Screening for Basic Social Needs at a Medical Home for Low-Income Children

Cited by 114 publications

References 22 publications

Mindfulness-Based Stress Reduction for Urban Youth

Mindfulness-Based Stress Reduction for Urban Youth

Addressing Social Determinants of Health at Well Child Care Visits: A Cluster RCT

A Road Map to Address the Social Determinants of Health Through Community Collaboration

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