Mobile Social Screening and Referral Intervention in a Pediatric Emergency Department

Published:September 05, 2022DOI:



      Many families in pediatric emergency departments (PED) have unmet social needs, which may be detected and addressed with the use of a digital social needs intervention. Our objective was to characterize the feasibility and effectiveness of utilizing personal phones or a PED tablet for screening and referral to social services.


      We conducted a prospective single-arm intervention study using a convenience sample of caregivers and adult patients in an urban PED between May 2019 and October 2020. Participants chose either their personal phone or a PED-provided tablet to use an app, “HelpSteps.” Participants self-selected need(s) then referrals to service agencies. Participants completed a 1-month follow-up. Clinicians were surveyed about screening and impact on visit.


      Of 266 participants enrolled, 55% of participants elected to use their personal phone. Of all participants, 67% self-selected at least 1 health-related social need; 34% selected 3 or more. The top 3 “most important” needs were housing (14%), education (12%), and fitness (12%). At one month follow-up, 44% of participants reported their top need was “completely” or “somewhat” solved. For 95% of encounters, clinicians reported the intervention did not increase length of stay.


      A mobile social needs intervention was feasible and effective at identifying and referring participants in the PED setting. While more than half of participants used their personal phones, several smartphone owners cited barriers and elected to use a tablet. Overall, participants found the app easy to use, appropriate for the PED, and the intervention had minimal impact on clinical flow.



      PED (Pediatric Emergency Department), EMR (Electronic Medical Record), CMMI (Center for Medicare and Medicaid Innovation), AHC (Accountable Health Communities), IPV (Interpersonal Violence), FPL (Federal Poverty Level), GED (General Educational Development)
      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


        • Thomas MMC
        • Miller DP
        • Morrissey TW.
        Food insecurity and child health.
        Pediatrics. 2019; 144
      1. Clark RE, Weinreb L, Flahive JM, Seifert RW. Infants Exposed To Homelessness: Health, Health Care Use, And Health Spending From Birth To Age Six. Health Aff (Millwood). 2019;38(5):721-728. doi:10.1377/hlthaff.2019.00090

        • Sandel M
        • Sheward R
        • de Cuba SE
        • et al.
        Unstable housing and caregiver and child health in renter families.
        Pediatrics. 2018; 141
        • Victorino CC
        • Gauthier AH.
        The social determinants of child health: Variations across health outcomes - A population-based cross-sectional analysis.
        BMC Pediatrics. 2009; 9: 1-12
      2. Income, poverty and health insurance coverage in the United States.
        US Census Bureau, 2020 (PublishedAccessed March 7, 2022)
        Poverty and Child Health in the United States.
        Pediatrics. 2016; 137 (e20160339-e20160339)
        • Fierman AH
        • Beck AF
        • Chung EK
        • et al.
        Redesigning Health Care Practices to Address Childhood Poverty.
        Academic Pediatrics. 2016; 16: S136-S146
        • Gottlieb L
        • Hessler D
        • Long D
        • Amaya A
        • Adler N.
        A Randomized Trial on Screening for Social Determinants of Health: the iScreen Study.
        Pediatrics. 2014; 134: e1611-e1618
        • Semple-Hess JE
        • Pham PK
        • Cohen SA
        • Liberman DB.
        Community Resource Needs Assessment Among Families Presenting to a Pediatric Emergency Department.
        Academic Pediatrics. 2019; 19: 378-385
        • Cullen D
        • Woodford A
        • Fein J.
        Food for Thought: A Randomized Trial of Food Insecurity Screening in the Emergency Department.
        Academic Pediatrics. 2019; 19: 646-651
        • Liberman DB
        • Pham PK
        • Semple-Hess JE.
        Social Emergency Medicine: Capitalizing on the Pediatric Emergency Department Visit to Screen and Connect Patients and Families to Community Resources.
        Academic Pediatrics. January 2022; (Published online)
        • De Marchis EH
        • Hessler D
        • Fichtenberg C
        • et al.
        Assessment of Social Risk Factors and Interest in Receiving Health Care-Based Social Assistance among Adult Patients and Adult Caregivers of Pediatric Patients.
        JAMA Network Open. 2020; 3
        • Byhoff E
        • De Marchis EH
        • Hessler D
        • et al.
        Part II: A Qualitative Study of Social Risk Screening Acceptability in Patients and Caregivers.
        American Journal of Preventive Medicine. 2019; 57: S38-S46
        • De Marchis EH
        • Hessler D
        • Fichtenberg C
        • et al.
        Part I: A Quantitative Study of Social Risk Screening Acceptability in Patients and Caregivers.
        American Journal of Preventive Medicine. 2019; 57: S25-S37
        • 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
        • Gottlieb L
        • Hessler D
        • Long D
        • et al.
        Are acute care settings amenable to addressing patient social needs: A sub-group analysis.
        American Journal of Emergency Medicine. 2018; 36: 2108-2109
        • 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 Pediatrics. 2016; 170: 1-7
        • Sokol R
        • Austin A
        • Chandler C
        • et al.
        Screening Children for Social Determinants of Health: A Systematic Review.
        Pediatrics. 2019; 144
        • Gottlieb LM
        • Wing H
        • Adler NE.
        A Systematic Review of Interventions on Patients’ Social and Economic Needs.
        American Journal of Preventive Medicine. 2017; 53: 719-729
        • Pantell MS
        • Hessler D
        • Wing H
        • et al.
        Association of 2 Social Needs Interventions With Child Emergency Department Use and Hospitalizations: A Secondary Analysis of a Randomized Clinical Trial.
        JAMA Pediatr. April 11, 2022; (Published online)
        • Hassan A
        • Scherer EA
        • Pikcilingis A
        • et al.
        Improving Social Determinants of Health: Effectiveness of a Web-Based Intervention.
        American Journal of Preventive Medicine. 2015; 49: 822-831
        • Wylie SA
        • Hassan A
        • Krull EG
        • et al.
        Assessing and referring adolescents’ health-related social problems: Qualitative evaluation of a novel web-based approach.
        Journal of Telemedicine and Telecare. 2012; 18: 392-398
        • Hassan A
        • Blood EA
        • Pikcilingis A
        • et al.
        Youths’ health-related social problems: Concerns often overlooked during the medical visit.
        Journal of Adolescent Health. 2013; 53: 265-271
        • Fleegler EW
        • Lieu TA
        • Wise PH
        Muret-Wagstaff S. Families’ Health-Related Social Problems and Missed Referral Opportunities.
        Pediatrics. 2007; 119: e1332-e1341
      3. Billioux A, Verlander K, Anthony S, Alley D. Standardized Screening for Health-Related Social Needs in Clinical Settings: The Accountable Health Communities Screening Tool. NAM Perspectives. 2017;7(5). doi:10.31478/201705b

        • Center for Medicare and Medicaid Innovation
        The Accountable Health Communities Health-Related Social Needs Screening Tool.
        2018 (Accessed August 11, 2022)
        • Curt AM
        • Kanak MM
        • Fleegler EW
        • Stewart AM.
        Increasing inclusivity in patient centered research begins with language.
        Preventive Medicine. 2021; : 149
        • Office of the Assistant Secretary for Planning and Evaluation
        HHS Poverty Guidelines and Federal Register References.
        2018 (2018 Poverty Guidelines. PublishedAccessed January 5, 2019)
        • Garg A
        • Brochier A
        • Messmer E
        • Fiori KP.
        Clinical Approaches to Reducing Material Hardship Due to Poverty: Social Risks/Needs Identification and Interventions.
        Academic Pediatrics. 2021; 21: S154-S160
        • Bottino CJ
        • Rhodes ET
        • Kreatsoulas C
        • Cox JE
        • Fleegler EW.
        Food Insecurity Screening in Pediatric Primary Care: Can Offering Referrals Help Identify Families in Need?.
        Academic Pediatrics. 2017; 17: 497-503
        • Real FJ
        • DeBlasio D
        • Rounce C
        • Henize AW
        • Beck AF
        • Klein MD.
        Opportunities for and Barriers to Using Smartphones for Health Education Among Families at an Urban Primary Care Clinic.
        Clinical Pediatrics. 2018; 57: 1281-1285
        • Shields WC
        • Omaki E
        • McDonald EM
        • et al.
        Cell Phone and Computer Use Among Parents Visiting an Urban Pediatric Emergency Department.
        Pediatric Emergency Care. 2018; 34
        • DeMartini TL
        • Beck AF
        • Klein MD
        • Kahn RS.
        Access to Digital Technology Among Families Coming to Urban Pediatric Primary Care Clinics.
        PEDIATRICS. 2013; 132
        • Steeves-Reece AL
        • Totten AM
        • Broadwell KD
        • Richardson DM
        • Nicolaidis C
        • Davis MM.
        Social Needs Resource Connections: A Systematic Review of Barriers, Facilitators, and Evaluation.
        Am J Prev Med. 2022; 62: e303-e315
        • Garg A
        • Cull W
        • Olson L
        • et al.
        Screening and Referral for Low-Income Families’ Social Determinants of Health by US Pediatricians.
        Academic Pediatrics. 2019; 000: 1-9
        • Saidinejad M
        • Teach SJ
        • Chamberlain JM.
        Internet access and electronic communication among families in an urban pediatric emergency department.
        Pediatric Emergency Care. 2012; 28: 553-557
        • Oldfield BJ
        • Casey M
        • Decew A
        • Morales SI
        • Olson DP.
        Screening for Social Determinants of Health among Children: Patients’ Preferences for Receiving Information to Meet Social Needs and a Comparison of Screening Instruments.
        Population Health Management. 2021; 24: 141-148