Social Needs Screening During Pediatric Emergency Department Visits: Disparities in Unmet Social Needs



      : To determine the prevalence of unmet social needs (USN) in a pediatric emergency department (PED) patient population and examine disparities in USN by self-selected language and patient demographics.


      : We surveyed a convenience sample of English- and Spanish-speaking caregivers of patients <18-years-old presenting to a free-standing children's hospital in Salt Lake City, Utah. In the caregiver's self-selected language, the pediatric version of the Screener for Intensifying Community Referrals for Health (p-SINCERE) assessed patient demographics and 10 areas of social needs. The primary outcome was presence of USN. Descriptive statistics compared 1) self-selected languages and 2) absence vs presence of USN. Patient and caregiver-level risk factors associated with USN were identified using multivariable logistic regression.


      : Of the 10156 patients seen in our PED from 04/01/2021 to 08/03/2021, there were 9922 eligible, 5357 approached, and 3987 enrolled caregivers. Of the 3987 caregivers enrolled, self-selected language was English for 3662(91.8%) and Spanish for 325(8.2%). There were 1680 enrolled caregivers with ≥1 USN, representing 39.7% of English-speaking and 70.2% of Spanish-speaking caregivers(p<0.001). The odds of having ≥1 USN was more than 2 times higher in Spanish-speakers than in English-speakers after adjustment.


      : Unmet social needs are common for families presenting for care to a PED, especially among Spanish-speaking caregivers. Furthermore, this study demonstrates disparities in limited English proficiency (LEP), race/ethnicity, and child insurance status. These findings support the practicality of utilizing the PED as an access point to initiate social need screening and referrals to address SDOH and health disparities.


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        • Chen Y
        • Thomson D.
        Child Poverty Increased Nationally During COVID.
        Especially Among Latino and Black Children. 2021; (Accessed 09/05/2021)
        • DuPre NC
        • Karimi S
        • Zhang CH
        • et al.
        County-level demographic, social, economic, and lifestyle correlates of COVID-19 infection and death trajectories during the first wave of the pandemic in the United States.
        Sci Total Environ. Sep 10 2021; 786147495
        • Perry BL
        • Aronson B
        • Pescosolido BA.
        Pandemic precarity: COVID-19 is exposing and exacerbating inequalities in the American heartland.
        Proc Natl Acad Sci U S A. Feb 23 2021; 118
      1. Healthy People 2030. U.S. Department of Health and Human Services. 09/05/2021, 2021. Accessed 07/03/2021, 2021.

      2. About Social Determinants of Health (SDOH). Centers for Disease Control and Prevention. 09/05/2021, 2021. Updated 2021-03-10T12:15:05Z. Accessed 09/05/2021, 2021.

        • Sandel M
        • Sheward R
        • Ettinger de Cuba S
        • et al.
        Unstable Housing and Caregiver and Child Health in Renter Families.
        Pediatrics. Feb 2018; 141
        • Ma CT
        • Gee L
        • Kushel MB.
        Associations between housing instability and food insecurity with health care access in low-income children.
        Ambul Pediatr. 2008; 8 (Jan-Feb): 50-57
        • Fuller AE
        • Garg A
        • Brown NM
        • Tripodis Y
        • Oyeku SO
        • Gross RS.
        Relationships Between Material Hardship, Resilience, and Health Care Use.
        Pediatrics. Feb 2020; 145
        • Weitzman M.
        Social Influences on Child Health.
        Pediatr Rev. 2021; vol. 7: 402-404
        • Knighton AJ
        • Savitz L
        • Belnap T
        • Stephenson B
        • VanDerslice J.
        Introduction of an Area Deprivation Index Measuring Patient Socioeconomic Status in an Integrated Health System: Implications for Population Health.
        EGEMS (Wash DC). 2016; 4: 1238
        • Maroko AR
        • Doan TM
        • Arno PS
        • Hubel M
        • Yi S
        • Viola D.
        Integrating Social Determinants of Health With Treatment and Prevention: A New Tool to Assess Local Area Deprivation.
        Prev Chronic Dis. Sep 15 2016; 13: E128
        • Victorino CC
        • Gauthier AH.
        The social determinants of child health: variations across health outcomes - a population-based cross-sectional analysis.
        BMC Pediatr. Aug 17 2009; 9: 53
        • Woolf SH
        • Braveman P.
        Where health disparities begin: the role of social and economic determinants–and why current policies may make matters worse.
        Health Aff (Millwood). Oct 2011; 30: 1852-1859
        • Wallace AS
        • Luther B
        • Guo JW
        • Wang CY
        • Sisler S
        • Wong B.
        Implementing a Social Determinants Screening and Referral Infrastructure During Routine Emergency Department Visits, Utah, 2017-2018.
        Prev Chronic Dis. Jun 18 2020; 17: E45
      3. Poverty and Child Health in the United States.
        Pediatrics. Apr 2016; 137
        • Garg A
        • Toy S
        • Tripodis Y
        • Silverstein M
        • Freeman E.
        Addressing social determinants of health at well child care visits: a cluster RCT.
        Pediatrics. Feb 2015; 135: e296-e304
        • DeLaroche AM
        • Rodean J
        • Aronson PL
        • et al.
        Pediatric Emergency Department Visits at US Children's Hospitals During the COVID-19 Pandemic.
        Pediatrics. Apr 2021; 147
        • Pines JM
        • Zocchi MS
        • Black BS
        • et al.
        Characterizing pediatric emergency department visits during the COVID-19 pandemic.
        Am J Emerg Med. Mar 2021; 41: 201-204
        • Lowe JT
        • Monteiro KA
        • Zonfrillo MR.
        Disparities in Pediatric Emergency Department Length of Stay and Utilization Associated With Primary Language.
        Pediatr Emerg Care. Sep 24 2021;
        • Semple-Hess JE
        • Pham PK
        • Cohen SA
        • Liberman DB.
        Community Resource Needs Assessment Among Families Presenting to a Pediatric Emergency Department.
        Acad Pediatr. May-Jun 2019; 19: 378-385
        • Terp S
        • Seabury SA
        • Arora S
        • Eads A
        • Lam CN
        • Menchine M.
        Enforcement of the Emergency Medical Treatment and Labor Act, 2005 to 2014.
        Ann Emerg Med. Feb 2017; 69 (e1): 155-162
        • Cone DC
        • Richardson LD
        • Todd KH
        • Betancourt JR
        • Lowe RA.
        Health care disparities in emergency medicine.
        Acad Emerg Med. Nov 2003; 10: 1176-1183
        • Cullen D
        • Woodford A
        • Fein J.
        Food for Thought: A Randomized Trial of Food Insecurity Screening in the Emergency Department.
        Acad Pediatr. 08 2019; 19: 646-651
        • Anderson ES
        • Hsieh D
        • Alter HJ.
        Social Emergency Medicine: Embracing the Dual Role of the Emergency Department in Acute Care and Population Health.
        Ann Emerg Med. Jul 2016; 68: 21-25
        • Walter LA
        • Schoenfeld EM
        • Smith CH
        • et al.
        Emergency department-based interventions affecting social determinants of health in the United States: A scoping review.
        Acad Emerg Med. Jun 2021; 28: 666-674
        • Cheng TL
        • Emmanuel MA
        • Levy DJ
        • Jenkins RR.
        Child Health Disparities: What Can a Clinician Do?.
        Pediatrics. Nov 2015; 136: 961-968
        • Butkus R
        • Rapp K
        • Cooney TG
        • Engel LS.
        Envisioning a Better U.S. Health Care System for All: Reducing Barriers to Care and Addressing Social Determinants of Health.
        Ann Intern Med. Jan 21 2020; 172 (Suppl): S50-s59
        • Artiga S
        • Hinton E.
        Beyond health care: the role of social determinants in promoting health and health equity.
        Health. 2019; 20: 1-13
        • Gundersen C
        • Ziliak JP.
        Food Insecurity And Health Outcomes.
        Health Aff (Millwood). Nov 2015; 34: 1830-1839
        • Kersten EE
        • Adler NE
        • Gottlieb L
        • et al.
        Neighborhood Child Opportunity and Individual-Level Pediatric Acute Care Use and Diagnoses.
        Pediatrics. May 2018; 141
        • Guo JW
        • Wallace AS
        • Luther BL
        • Wong B.
        Psychometric Evaluation of the Screener for Intensifying Community Referrals for Health.
        Eval Health Prof. Jul 8 2021; (1632787211029360)
        • R: A language and environment for statistical computing
        • Gottlieb L
        • Hessler D
        • Long D
        • Amaya A
        • Adler N.
        A randomized trial on screening for social determinants of health: the iScreen study.
        Pediatrics. Dec 2014; 134: e1611-e1618
        • Flores G
        • Abreu M
        • Tomany-Korman SC.
        Limited english proficiency, primary language at home, and disparities in children's health care: how language barriers are measured matters.
        Public Health Rep. Jul-Aug 2005; 120: 418-430
      4. Health Coverage of Immigrants. Kaiser Family Foundation. Updated 2022-04-06. Accessed 04/15/2022, 2022.