Abstract
Objective
Despite strong evidence that social factors have a large influence on child health,
systematic screening for social needs is not performed universally in pediatric primary
care. This is due to multiple barriers, including concerns about acceptability to
families. This study sought to assess family acceptability of social needs screening
in pediatric primary care.
Methods
Eight semi-structured focus groups were performed with English and Spanish-speaking
caregivers of pediatric patients from a diverse academic medical center. Focus groups
explored the acceptability of social domains including housing, education, finances,
food access, and safety. Focus group transcripts were qualitatively analyzed to identify
themes.
Results
Four salient themes emerged: 1) the acceptability of social determinants of health
screening questions was tied to participants’ understanding of the connection between
the topic and child health, 2) families preferred a warm handoff to community services,
3) families feared child protective services intervention as a result of sharing unmet
social needs, and 4) positive provider rapport was an important factor in choosing
to share social needs.
Conclusions
Pediatric primary care providers should feel comfortable implementing social needs
screening when they can clearly explain the connection to child health. They should
become knowledgeable about organizations and partners within their communities and
feel empowered to connect patients to these resources.
Keywords
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References
- Socioeconomic differences in children's health: how and why do these relationships change with age?.Psychol Bull. 2002; 128: 295-329https://doi.org/10.1037/0033-2909.128.2.295
- Understanding health disparities: the role of race and socioeconomic status in children's health.Am J Public Health. 2006; 96: 702-708https://doi.org/10.2105/AJPH.2004.048124
- Chipping away at health: more on the relationship between income and child health.Health Aff. 2007; 26: 331-344https://doi.org/10.1377/hlthaff.26.2.331
- The health of children of low-income families.Can Med Assoc J. 1987; 137: 485-490
- County health rankings: relationships between determinant factors and health outcomes.Am J Prev Med. 2016; 50: 129-135https://doi.org/10.1016/j.amepre.2015.08.024
Children below 200 percent poverty. Kids Count Data Center. Available at: https://datacenter.kidscount.org/data/tables/47-children-below-200-percent-poverty. Accessed August 30, 2020.
- Evaluating strategies for reducing health disparities by addressing the social determinants of health.Health Aff (Millwood). 2016; 35: 1416-1423https://doi.org/10.1377/hlthaff.2015.1357
- Improving the management of family psychosocial problems at low-income children's well-child care visits: the we care project.Pediatrics. 2007; 120: 547-558https://doi.org/10.1542/peds.2007-0398
- Screening and referral for low-income families' social determinants of health by US pediatricians.Acad Pediatr. 2019; 19: 875-883https://doi.org/10.1016/j.acap.2019.05.125
- The prevalence of social care in US health care settings depends on how and whom you ask.BMC Health Serv Res. 2020; 20481https://doi.org/10.1186/s12913-020-05338-8
- 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: 1389-1395https://doi.org/10.1007/s11606-019-05588-1
- Assessment of social risk factors and interest in receiving health care-based social assistance among adult patients and adult caregivers of pediatric patients.JAMA Netw Open. 2020; 3e2021201https://doi.org/10.1001/jamanetworkopen.2020.21201
- Caregiver opinion of in-hospital screening for unmet social needs by pediatric residents.Acad Pediatr. 2016; 16: 161-167https://doi.org/10.1016/j.acap.2015.06.002
- Comparison of community-level and patient-level social risk data in a network of community health centers.JAMA Netw Open. 2020; 3e2016852https://doi.org/10.1001/jamanetworkopen.2020.16852
- Differences in pediatric residents’ social needs screening practices across health care settings.Hosp Pediatr. 2020; 10: 443-446https://doi.org/10.1542/hpeds.2019-0286
- Caregiver and pediatric health care provider views on social needs identification.J Prim Care Community Health. 2020; 112150132720923085https://doi.org/10.1177/2150132720923085
- Screening for social determinants of health among children and families living in poverty: a guide for clinicians.Curr Probl Pediatr Adolesc Health Care. 2016; 46: 135-153https://doi.org/10.1016/j.cppeds.2016.02.004
- Screening children for social determinants of health: a systematic review.Pediatrics. 2019; 144e20191622https://doi.org/10.1542/peds.2019-1622
- Linking urban families to community resources in the context of pediatric primary care.Patient Educ Couns. 2010; 79: 251-254https://doi.org/10.1016/j.pec.2009.10.011
- Clinical approaches to reducing material hardship due to poverty: social risks/needs identification and interventions.Acad Pediatr. 2021; 21: S154-S160https://doi.org/10.1016/j.acap.2021.02.007
- An integrative review of social determinants of health assessment and screening tools used in pediatrics.J Pediatr Nurs. 2017; 37: 22-28https://doi.org/10.1016/j.pedn.2017.08.022
- It's about trust: low-income parents’ perspectives on how pediatricians can screen for social determinants of health.Health Serv Res. 2020; 55: 134-135https://doi.org/10.1111/1475-6773.13524
- Part II: a qualitative study of social risk screening acceptability in patients and caregivers.Am J Prev Med. 2019; 57: S38-S46https://doi.org/10.1016/j.amepre.2019.07.016
- Suburban families' experience with food insecurity screening in primary care practices.Pediatrics. 2017; 140e20170320https://doi.org/10.1542/peds.2017-0320
- Integrating Social Determinants of Health Into Health Supervision Visits.April. 2019;
- Qualitative program evaluation of social determinants of health screening and referral program.PLoS One. 2020; 15e0242964https://doi.org/10.1371/journal.pone.0242964
- Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inform. 2009; 42: 377-381https://doi.org/10.1016/j.jbi.2008.08.010
- The REDCap consortium: building an international community of software partners.J Biomed Inform. 2019; 95103208https://doi.org/10.1016/j.jbi.2019.103208
- Doing Qualitative Research: Multiple Strategies.SAGE, Thousand Oaks, Calif1992
- Techniques to identify themes.Field Methods. 2003; 15: 85-109https://doi.org/10.1177/1525822x02239569
- Promoting food security for all children.Pediatrics. 2015; 136: e1431-e1438https://doi.org/10.1542/peds.2015-3301
- Clinical decision support tool for parental tobacco treatment in primary care.Pediatrics. 2016; 137e20154185https://doi.org/10.1542/peds.2015-4185
- Screening discordance and characteristics of patients with housing-related social risks.Am J Prev Med. 2021; 61: e1-e12https://doi.org/10.1016/j.amepre.2021.01.027
- The effects of housing interventions on child health.Pediatr Ann. 2004; 33: 474-481https://doi.org/10.3928/0090-4481-20040701-14
- Well homes initiative: a home-based intervention to address housing-related Ill health.Health Educ Behav. 2020; 47: 836-844https://doi.org/10.1177/1090198120911612
- Exploratory study of "real world" implementation of a clinical poverty tool in diverse family medicine and pediatric care settings.Int J Equity Health. 2019; 18: 200https://doi.org/10.1186/s12939-019-1085-0
Wilson-Hall L, McPeak K, Constant B, et al. Screening for social needs in pediatrics: how can we ensure it is family-centered and effective? PolicyLab at Children's Hospital of Philadelphia; 2020. Available at: https://bit.ly/ScreeningSocialNeeds-Pediatrics. Accessed May 4, 2020.
- Effects of social needs screening and in-person service navigation on child health: a randomized clinical trial.JAMA Pediatr. 2016; 170e162521https://doi.org/10.1001/jamapediatrics.2016.2521
- Addressing social determinants of health at well child care visits: a cluster RCT.Pediatrics. 2015; 135: e296-e304https://doi.org/10.1542/peds.2014-2888
- Community health workers as drivers of a successful community-based disease management initiative.Am J Public Health. 2012; 102: 1443-1446https://doi.org/10.2105/AJPH.2011.300585
- Systematic review of U.S.-based randomized controlled trials using community health workers.Prog Community Health Partnersh. 2007; 1: 371-381https://doi.org/10.1353/cpr.2007.0035
- Addressing social determinants of health at well child care visits: a cluster RCT.Pediatrics. 2015; 135: e296-e304https://doi.org/10.1542/peds.2014-2888
- Transforming well-child care to meet the needs of families at the intersection of racism and poverty.Acad Pediatr. 2021; 21: S102-S107https://doi.org/10.1016/j.acap.2021.08.004
- Poor Children by Parents' Nativity: What Do We Know?.National Center for Children in Poverty, New York, NY2011
- Disparities in utilization of social determinants of health referrals among children in immigrant families.Front Pediatr. 2018; 6: 207https://doi.org/10.3389/fped.2018.00207
Article info
Publication history
Published online: July 11, 2022
Accepted:
July 3,
2022
Received:
March 9,
2022
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
Copyright © 2022 by Academic Pediatric Association
