Social care practices and perspectives among U.S. pediatric emergency medicine fellowship programs

Abstract

Background The emergence of social emergency medicine—the incorporation of social context into the structure and practice of emergency care—has brought forth greater embracement of the social determinants of health by medical professionals, yet workforce practices and training have remained elusive. Academic literature particularly in the field of pediatric emergency medicine (PEM) fellowship training is lacking relative to general pediatrics and adult emergency medicine. Methods The primary objective of this study was to assess the social care knowledge, perspectives, and training of PEM program directors (PDs) and fellows across a national cross‐sectional sample. A secondary aim was to uncover key actionable areas for the development of social care curricula in PEM training programs. A social care practices assessment tool was developed via snowball sampling interviews among clinician researcher experts and disseminated to PEM PDs and fellows nationally in accredited academic PEM training institutions. Results A total of 153 participants—44 PDs (49% response rate) and 109 fellows (28%)—completed the assessment tool. Responses among PDs and fellows were highly concordant. Only 12% reported regular use of a standardized social needs screening tool. The majority felt unprepared to assist families with social needs and less than half felt comfortable talking to families about social need. At the same time, social care was highly valued by 73% of participants. All participants felt that providing social care training during PEM fellowship would be beneficial. PDs and fellows identified five priority areas for PEM curricular development. Conclusions PEM PDs and fellows have an overall favorable perception of social care yet report significant deficits in current practice organization and training. This study is part of a larger national collaborative advocacy project to organize and advance social care delivery across academic PEM training institutions through evidence‐based approaches, best practices, and expert consensus.

Pediatric emergency department organization and social care practices among U.S. fellowship programs

“…While multiple studies have documented patient and family preference for electronic, self-administered screening, 20,31,32 providers including physicians, nurses, social workers, case managers, and administrators share favorable views of systematic universal screening and referral platforms incorporated into clinical workflow. 6,13,16,33,34 As ED social care process models continue to be developed nationally and are assessed for feasibility and sustainability, we argue that physician perspective, and likely that of other providers including nurses and social workers, is an important measure for success.…”

“…5 We demonstrated in a preceding study that the majority of a national cohort of pediatric emergency medicine (PEM) fellows and program directors (PDs) highly valued social care yet lacked organizational structure to address common social risk such as housing instability, food insecurity, access to public benefits, and transportation assistance. 6 In 1999, Dr. James Gordon eloquently theorized the ED as a social welfare institution and societal resource functioning as a "social triage" and an extension of existing community resources. 7 While screening for social risk has become a norm among pediatricians in the office setting, common practice in the emergency setting falls well short of a coordinated, systematic approach integrating social care into clinical care.…”

“…2 Successful models have been published by individual medical centers; however, the majority of pediatric emergency departments (PEDs) lack comprehensive structure to support two primary social care functions: awareness and assistance. 3,5,6,11,12 Awareness includes health care system activities that identify social risk, while assistance refers to those that reduce social risk by connecting patients with relevant community resources. 5 Even less is known regarding PEM physician perspectives of social care structure and operations.…”

“…Various research has documented physicians' strong support of social care integration into emergency medical care, with limited time and training as principal barriers at the physician level. 6,[13][14][15] Lessons learned from pediatric and adult emergency medicine social care networks suggest that effective and sustainable strategies recognize these physician-level limitations in pursuit of organizational solutions. 3,[16][17][18][19][20] In the ED, these macrolevel interventions, or organizational factors, aim to operationalize social risk awareness and assistance by integrated workflow approaches, community referral databases, and leveraging social work services.…”

“…Social care includes activities that address health‐related social risk and social needs, whereas social risk encompasses social conditions associated with poor health, social needs are the specific conditions in which patients and their families request assistance 5 . We demonstrated in a preceding study that the majority of a national cohort of pediatric emergency medicine (PEM) fellows and program directors (PDs) highly valued social care yet lacked organizational structure to address common social risk such as housing instability, food insecurity, access to public benefits, and transportation assistance 6 …”