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



      It is critical that pediatric residents learn to effectively screen families for active and addressable social needs (ie, 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.


      During an 18-month period, interns rotating on 1 of 2 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 examination (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 postintervention period, every third H&P was reviewed to determine median duration of continued IHELP use.


      A total of 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 < .001). Among H&Ps with documented use of IHELP, specificity was 0.96 (95% confidence interval 0.87–0.99) and sensitivity was 0.63 (95% confidence interval 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 (interquartile range 1–10 months).


      A brief intervention increased resident screening and detection of social needs, leading to important referrals to address those needs.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Singh G.K.
        • Yu S.M.
        US childhood mortality, 1950 through 1993: trends and socioeconomic differentials.
        Am J Public Health. 1996; 86: 505-512
        • Newacheck P.W.
        • Hung Y.Y.
        • Park M.J.
        • et al.
        Disparities in adolescent health and health care: does socioeconomic status matter?.
        Health Serv Res. 2003; 38: 1235-1252
        • Victorino C.C.
        • Gauthier A.H.
        The social determinants of child health: variations across health outcomes—a population-based cross-sectional analysis.
        BMC Pediatr. 2009; 9: 53
        • Fleegler E.W.
        • Lieu T.A.
        • Wise P.H.
        • et al.
        Families' health-related social problems and missed referral opportunities.
        Pediatrics. 2007; 119: e1332-e1341
        • Garg A.
        • Butz A.M.
        • Dworkin P.H.
        • et al.
        Screening for basic social needs at a medical home for low-income children.
        Clin Pediatr. 2008; 48: 32-36
        • Keller D.
        • Jones N.
        • Savageau J.
        • et al.
        Development of a brief questionnaire to identify families in need of legal advocacy to improve child health.
        Ambul Pediatr. 2008; 8: 266-269
        • Fiscella K.
        • Burstin H.R.
        • Nerenz D.R.
        Quality measures and sociodemographic risk factors: to adjust or not to adjust.
        JAMA. 2014; 312: 2615-2616
        • Institute of Medicine
        Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2.
        National Academies Press, Washington, DC2014
        • Guralnick S.
        • Ludwig S.
        • Englander E.
        Domain of competence: systems-based practice.
        Acad Pediatr. 2014; 14: S70-S79
        • Klein M.D.
        • Schumacher D.J.
        • Sandel M.
        Assessing and managing the social determinants of health: defining an entrustable professional activity to assess residents’ ability to meet societal needs.
        Acad Pediatr. 2014; 14: 10-13
        • Kenyon C.
        • Sandel M.
        • Silverstein M.
        • et al.
        Revisiting the social history for child health.
        Pediatrics. 2007; 120: e734-e738
        • Garg A.
        • Butz A.M.
        • Dworkin P.H.
        • et al.
        Improving the management of family psychosocial problems at low-income children's well-child care visits: the WE CARE project.
        Pediatrics. 2007; 120: 547-558
        • Garg A.
        • Marino M.
        • Vikani A.R.
        • et al.
        Addressing families' unmet social needs within pediatric primary care: the health leads model.
        Clin Pediatr. 2012; 51: 1191-1193
        • Gottlieb L.
        • Hessler D.
        • Long D.
        • et al.
        A randomized trial on screening for social determinants of health: the iScreen study.
        Pediatrics. 2014; 134: e1611-e1618
        • Klein M.D.
        • Alcamo A.M.
        • Beck A.F.
        • et al.
        Can a video curriculum on the social determinants of health affect residents “practice and families” perceptions of care?.
        Acad Pediatr. 2014; 14: 159-166
        • Klein M.D.
        • Kahn R.S.
        • Baker R.C.
        • et al.
        Training in social determinants of health in primary care: does it change resident behavior?.
        Acad Pediatr. 2011; 11: 387-393
        • Schwartz A.
        • Weiner S.J.
        • Harris I.B.
        • et al.
        An educational intervention for contextualizing patient care and medical students' abilities to probe for contextual issues in simulated patients.
        JAMA. 2010; 304: 1191-1197
        • Berry J.G.
        • Hall D.E.
        • Kuo D.Z.
        • et al.
        Hospital utilization and characteristics of patients experiencing recurrent readmissions within children’s hospitals.
        JAMA. 2011; 305: 682-690
        • Morse R.B.
        • Hall M.
        • Fieldston E.S.
        • et al.
        Hospital-level compliance with asthma care quality measures at children's hospitals and subsequent asthma-related outcomes.
        JAMA. 2011; 306: 1454-1460
        • Feudtner C.
        • Hays R.M.
        • Haynes G.
        • et al.
        Deaths attributed to pediatric complex chronic conditions: national trends and implications for supportive care services.
        Pediatrics. 2001; 107: e99
        • Frieden T.R.
        A framework for public health action: the health impact pyramid.
        Am J Public Health. 2010; 100: 590-595
        • Collie-Akers V.
        • Schultz J.A.
        • Carson V.
        • et al.
        REACH 2010: Kansas City, Missouri: evaluating mobilization strategies with neighborhood and faith organizations to reduce risk for health disparities.
        Health Promot Pract. 2009; 10: 118S-127S
        • Hassan A.
        • Blood E.A.
        • Pikcilingis A.
        • et al.
        Youths' health-related social problems: concerns often overlooked during the medical visit.
        J Adolesc Health. 2013; 53: 265-271
        • Garg A.
        • Toy S.
        • Tripodis Y.
        • et al.
        Addressing social determinants of health at well child care visits: a cluster RCT.
        Pediatrics. 2015; 135: e296-e304

      Linked Article

      • Moving From Social Risk Assessment and Identification to Intervention and Treatment
        Academic PediatricsVol. 16Issue 2
        • Preview
          Clinical care seeks to match the right patient to the right treatment. Clinicians use histories and physicals to guide assessment and to determine diagnosis and management plans. This pattern of assessment, identification, and treatment typically focuses on symptoms and diseases. However, mounting evidence suggests that social determinants of health (SDH) may be just as, if not more, relevant to clinical outcomes than many of the medical or biologic determinants that often dominate our focus. It is therefore natural to consider how we might reliably and effectively integrate assessment, identification, and treatment of the SDH into clinical practice.
        • Full-Text
        • PDF