Caregiver Opinion of In-Hospital Screening for Unmet Social Needs by Pediatric Residents



      Child health is strongly influenced by social determinants. Little is known about the opinions of primary caregivers regarding the physicians' role in addressing social needs. Our objective was to examine caregivers' opinions about that role and any associations between those opinions, previous exposure to screening for needs by pediatric residents, and socioeconomic status (SES).


      Cross-sectional survey study of caregivers of hospitalized children. The survey collected information on caregiver opinion regarding their ability to ask physicians for help with social needs, whether physicians know how to help with those needs, and whether physicians should ask about social needs. The chi square test was used to identify associations between caregiver opinions, prior screening by a resident at admission, and SES (determined by census tract median household income).


      Surveys were completed by 143 caregivers (79% participation). Most respondents agreed that they could ask their physician for help (54.5%), that their physician knows how to help (64.3%), and that physicians should ask about social needs (71.3%). Previously screened caregivers had more favorable opinions about asking for help (76.2% vs 45.5%, P < .01), whether their physician knows how to help (81.0% vs 57.4%, P = .02), and physician screening for unmet needs (85.7% vs 65.3%, P = .03). There were no SES differences in opinion.


      Caregivers have favorable opinions of the physician's role in addressing the social determinants of health, especially after being screened. Physicians should be confident in the acceptability of screening families for social 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
        • 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
        • 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
        • Shonkoff J.P.
        • Garner A.S.
        • Committee on Psychosocial Aspects of Child and Family Health' Committee on Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral Pediatrics
        • et al.
        The lifelong effects of early childhood adversity and toxic stress.
        Pediatrics. 2012; 129: e232-e246
        • Adler N.E.
        • Stewart J.
        Health disparities across the lifespan: meaning, methods, and mechanisms.
        Ann N Y Acad Sci. 2010; 1186: 5-23
        • Kawachi I.
        • Kennedy B.P.
        Income inequality and health: pathways and mechanisms.
        Health Serv Res. 1999; 34: 215-227
        • Berkman L.
        • Glass T.
        Social integration, social networks, social support, and health.
        in: Berkman L. Kawachi I. Social Epidemiology. Oxford University Press, New York, NY2000: 137-173
        • Lachman M.E.
        • Weaver S.L.
        The sense of control as a moderator of social class differences in health and well-being.
        J Pers Soc Psychol. 1998; 74: 763-773
        • Adler N.
        • Snibbe A.
        The role of psychosocial processes in explaining the gradient between socioeconomic status and health.
        Curr Directions Pscyhol Sci. 2003; 12: 119-123
        • Casey P.H.
        • Szeto K.L.
        • Robbins J.M.
        • et al.
        Child health-related quality of life and household food security.
        Arch Pediatr Adolesc Med. 2005; 159: 51-56
        • Kirkpatrick S.I.
        • McIntyre L.
        • Potestio M.L.
        Child hunger and long-term adverse consequences for health.
        Arch Pediatr Adolesc Med. 2010; 164: 754-762
        • Larson K.
        • Halfon N.
        Family income gradients in the health and health care access of US children.
        Matern Child Health J. 2009; 14: 332-342
        • Council on Community Pediatrics
        Providing care for children and adolescents facing homelessness and housing insecurity.
        Pediatrics. 2013; 131: 1206-1210
        • Rosenstreich D.L.
        • Eggleston P.
        • Kattan M.
        • et al.
        The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma.
        N Engl J Med. 1997; 336: 1356-1363
        • Frank D.A.
        • Casey P.H.
        • Black M.M.
        • et al.
        Cumulative hardship and wellness of low-income, young children: multisite surveillance study.
        Pediatrics. 2010; 125: e1115-e1123
        • Fieldston E.S.
        • Zaniletti I.
        • Hall M.
        • et al.
        Community household income and resource utilization for common inpatient pediatric conditions.
        Pediatrics. 2013; 132: e1592-e1601
        • Institute of Medicine
        Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2.
        National Academies Press, Washington, DC2014: 1-375
        • 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
      1. Goldstein D, Holmes J. 2011 physicians' daily life report. Available at: Accessed June 6, 2015.

        • 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
        • 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
        • 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
        • 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
        • Weiner S.J.
        • Schwartz A.
        • Weaver F.
        • et al.
        Contextual errors and failures in individualizing patient care: a multicenter study.
        Ann Intern Med. 2010; 153: 69-75
        • 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
        • Feudtner C.
        • Feinstein J.A.
        • Satchell M.
        • et al.
        Shifting place of death among children with complex chronic conditions in the United States, 1989–2003.
        JAMA. 2007; 297: 2725-2732
        • Krieger N.
        • Chen J.T.
        • Waterman P.D.
        • et al.
        Choosing area based socioeconomic measures to monitor social inequalities in low birth weight and childhood lead poisoning: the Public Health Disparities Geocoding Project (US).
        J Epidemiol Commun Health. 2003; 57: 186-199
        • Krieger N.
        Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology.
        Am J Public Health. 1992; 82: 703-710
        • Geronimus A.T.
        • Bound J.
        Use of census-based aggregate variables to proxy for socioeconomic group: evidence from national samples.
        Am J Epidemiol. 1998; 148: 475-486
        • Kenyon C.
        • Sandel M.
        • Silverstein M.
        • et al.
        Revisiting the social history for child health.
        Pediatrics. 2007; 120: e734-e738
        • Hagan J.F.
        • Shaw J.S.
        • Duncan P.M.
        Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents.
        3rd ed. American Academy of Pediatrics, Elk Grove, Ill2008
        • 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
        • 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
        • Beck A.F.
        • Klein M.D.
        • Kahn R.S.
        Identifying social risk via a clinical social history embedded in the electronic health record.
        Clin Pediatr. 2012; 51: 972-977
        • Accreditation Council for Graduate Medical Education; American Board of Pediatrics
        The Pediatrics Milestone Project.
        (Available at:) (Accessed June 6, 2015)
        • Kitchen A.
        • Brook J.
        Social work at the heart of the medical team.
        Social Work Health Care. 2005; 40: 1-18
        • 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
        • Zuckerman B.
        • Sandel M.
        • Smith L.
        • et al.
        Why pediatricians need lawyers to keep children healthy.
        Pediatrics. 2004; 114: 224-228
        • Klein M.D.
        • Beck A.F.
        • Henize A.W.
        • et al.
        Doctors and lawyers collaborating to HeLP children—outcomes from a successful partnership between professions.
        J Health Care Poor Underserved. 2013; 24: 1063-1073
        • 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