Social Determinants of Health Needs and Pediatric Health Care Use

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.…”

“…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. Problems with utilities, such as utilities being shut off, threats of utilities being shut off or concern about not being able to pay for utilities and in relation to heating the home,43 73 was asked as part of social screening in eighteen (n=18) studies 43 47 65–68 70 71 74–76 78 79 88 90 91 100 106. The questions about utilities were often asked alongside broader housing question in screening tools, for example, “[Are you having] problems with housing conditions (overcrowding, evictions, lead, utilities, mold, rodents)?”100 and “Do you have trouble paying utilities or maintaining a safe place to live?”91…”

“…The Injury Prevention tool was tested for reliability 91. Insufficient information was provided on the validity, feasibility or acceptability of the tools used in 14 studies 30 65 68 69 73 82 85 88 91 93 100–102 105. The information provided for the Quick Risks and Assets Family Triage tool showed some indication of content, construct and predictive validity, however it is unclear whether it was validated 97.…”