Engagement in a Social Needs Navigation Program and Healthcare Utilization in Pediatric Primary Care

      • Conclusions
        Addressing families’ social needs through resource linkage and navigation can improve well-child visit attendance.


      Background and Objectives

      Evidence for social needs interventions on resource linkage has grown over the past decade. Though social and economic needs predict healthcare utilization, few studies have assessed social needs interventions on these outcomes. The objective of this study was to examine the association between enrollment in a clinic-based social needs program on subsequent well child visit (WCV) attendance and emergency department (ED) use in two primary care clinics.


      A retrospective cohort study was conducted of patients in two clinics referred to a social risk screening and navigation program between June-August 2018. We compared healthcare utilization over the subsequent 12 months for those who completed a full intake and received resource navigation (enrolled) to those referred (not enrolled). Logistic regression was used to assess the association between enrollment with WCV attendance and ED visits.


      During the study period, of the 969 patients referred to the program, 761 were enrolled across the two clinics. At both sites, the majority of enrolled patients had high WCV attendance post intervention, (Site A: 81.6%, Site B: 71.4%). High WCV attendance for non-enrolled but referred patients was significantly lower (Site A: 52.7%, Site B: 35.0%). Enrolled participants were significantly more likely to have high WCV attendance than non-enrolled patients, adjusting for pre-intervention utilization (Site A aOR: 5.83, Site B aOR: 4.20). There were no significant differences in emergency department use at either clinic.



      WCV ((well-child visits)), ED ((emergency department)), SDOH ((social determinants of health))
      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


        • Braveman P
        • Barclay C.
        Health disparities beginning in childhood: a life-course perspective.
        Pediatrics. 2009; 124 (Suppl): S163-S175
        • Shonkoff JP
        • Garner AS
        Committee on Psychosocial Aspects of Child and Family Health; Committee on Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral Pediatrics. The lifelong effects of early childhood adversity and toxic stress.
        Pediatrics. 2012; 129: e232-e246
        • Black MM
        • Cutts DB
        • Frank DA
        • et al.
        Special Supplemental Nutrition Program for Women, Infants, and Children participation and infants' growth and health: a multisite surveillance study.
        Pediatrics. 2004; 114: 169-176
        • Bauman LJ
        • Silver EJ
        • Stein RE.
        Cumulative social disadvantage and child health.
        Pediatrics. 2006; 117: 1321-1328
        • Colvin JD
        • Zaniletti I
        • Fieldston ES
        • et al.
        Socioeconomic status and in-hospital pediatric mortality.
        Pediatrics. 2013; 131: e182-e190
        • Rushton Jr, FE
        American Academy of Pediatrics Committee on Community Health Services. The pediatrician's role in community pediatrics.
        Pediatrics. 2005; 115: 1092-1094
      1. APA Task Force on Childhood Poverty. A strategic road-map: committed to bringing the voice of pediatricians to the most important problem facing children in the US today.

        • Davidson KW
        • Krist AH
        • Tseng CW
        • et al.
        Incorporation of Social Risk in US Preventive Services Task Force Recommendations and Identification of Key Challenges for Primary Care [published online ahead of print, 2021 Sep 1].
        JAMA. 2021; (10.1001/jama.2021.12833)
        • Eder Michelle
        • et al.
        Screening and Interventions for Social Risk Factors: Technical Brief to Support the US Preventive Services Task Force.
        JAMA. 2021;
        • Garg A
        • Toy S
        • Tripodis Y
        • Silverstein M
        • Freeman E.
        Addressing social determinants of health at well child care visits: a cluster RCT.
        Pediatrics. 2015; 135: e296-e304
        • Garg A
        • Butz AM
        • Dworkin PH
        • Lewis RA
        • Thompson RE
        • Serwint JR.
        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
        • Sandhu S
        • Xu J
        • Blanchard L
        • et al.
        A Community Resource Navigator Model: Utilizing Student Volunteers to Integrate Health and Social Care in a Community Health Center Setting.
        Int J Integr Care. 2021; 21 (Published 2021 Feb 5): 2
        • Beck AF
        • Cohen AJ
        • Colvin JD
        • et al.
        Perspectives from the Society for Pediatric Research: interventions targeting social needs in pediatric clinical care.
        Pediatr Res. 2018; 84: 10-21
        • Gottlieb LM
        • Hessler D
        • Long D
        • et al.
        Effects of Social Needs Screening and In-Person Service Navigation on Child Health: A Randomized Clinical Trial.
        JAMA Pediatr. 2016; 170e162521
        • Berkowitz SA
        • Hulberg AC
        • Standish S
        • Reznor G
        • Atlas SJ.
        Addressing Unmet Basic Resource Needs as Part of Chronic Cardiometabolic Disease Management.
        JAMA Intern Med. 2017; 177: 244-252
        • Berkowitz SA
        • Seligman HK
        • Meigs JB
        • Basu S.
        Food insecurity, healthcare utilization, and high cost: a longitudinal cohort study.
        Am J Manag Care. 2018; 24: 399-404
        • Mosen DM
        • Banegas MP
        • Benuzillo JG
        • Hu WR
        • Brooks NB
        • Ertz-Berger BL.
        Association Between Social and Economic Needs With Future Healthcare Utilization.
        Am J Prev Med. 2020; 58: 457-460
        • Hatef E
        • Ma X
        • Rouhizadeh M
        • Singh G
        • Weiner JP
        • Kharrazi H.
        Assessing the Impact of Social Needs and Social Determinants of Health on Health Care Utilization: Using Patient- and Community-Level Data.
        Popul Health Manag. 2021; 24: 222-230
        • Schickedanz A
        • Sharp A
        • Hu YR
        • et al.
        Impact of Social Needs Navigation on Utilization Among High Utilizers in a Large Integrated Health System: a Quasi-experimental Study.
        J Gen Intern Med. 2019; 34: 2382-2389
        • Vasan A
        • Morgan JW
        • Mitra N
        • et al.
        Effects of a standardized community health worker intervention on hospitalization among disadvantaged patients with multiple chronic conditions: A pooled analysis of three clinical trials.
        Health Serv Res. 2020; 55 (Suppl 2(Suppl): 894-901
        • Thompson MP
        • Podila PSB
        • Clay C
        • et al.
        Community navigators reduce hospital utilization in super-utilizers.
        Am J Manag Care. 2018; 24: 70-76
        • 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. 2020; 17 (Published 2020 Jun 18): E45
        • Pantell MS
        • Hessler D
        • Long D
        • et al.
        Effects of In-Person Navigation to Address Family Social Needs on Child Health Care Utilization: A Randomized Clinical Trial.
        JAMA Netw Open. 2020; 3 (Published 2020 Jun 1)e206445
        • Arbour M.C.
        • Floyd B.
        • Morton S.
        • Hampton P.
        • Sims J.M.
        • Doyle S.
        • Sege R.
        Cross-Sector Approach Expands Screening and Addresses Health-Related Social Needs in Primary Care.
        Pediatrics. 2021; 148 (... &)
        • Selden TM
        Compliance with well-child visit recommendations: evidence from the Medical Expenditure Panel Survey, 2000-2002.
        Pediatrics. 2006; 118: e1766-e1778
        • Polk S
        • Leifheit KM
        • Thornton R
        • Solomon BS
        • DeCamp LR
        Addressing the Social Needs of Spanish- and English-Speaking Families in Pediatric Primary Care.
        Acad Pediatr. 2020; 20: 1170-1176
        • Garg A
        • Marino M
        • Vikani AR
        • Solomon BS
        Addressing families' unmet social needs within pediatric primary care: the health leads model.
        Clin Pediatr (Phila). 2012; 51: 1191-1193
        • Garg A
        • Sarkar S
        • Marino M
        • Onie R
        • Solomon BS
        Linking urban families to community resources in the context of pediatric primary care.
        Patient Educ Couns. 2010; 79: 251-254
        • Wolf ER
        • Hochheimer CJ
        • Sabo RT
        • et al.
        Gaps in Well-Child Care Attendance Among Primary Care Clinics Serving Low-Income Families.
        Pediatrics. 2018; 142e20174019
        • Quinn C
        • Johnson K
        • Raney C
        • et al.
        In the Clinic They Know Us": Preferences for Clinic-Based Financial and Employment Services in Urban Pediatric Primary Care.
        Acad Pediatr. 2018; 18: 912-919
        • Rogers AJ
        • Hamity C
        • Sharp AL
        • Jackson AH
        • Schickedanz AB
        Patients' Attitudes and Perceptions Regarding Social Needs Screening and Navigation: Multi-site Survey in a Large Integrated Health System.
        J Gen Intern Med. 2020; 35: 1389-1395