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Screening, referral at well-child visits improve family access to necessities

Implementing a screening and referral process for families attending well-child care visits increased pediatrician knowledge of their patients’ social determinants of health and increased the number of families referred to community resources, according to research presented at the Pediatric Academic Societies 2018 Meeting.

"In 2016, the AAP recommended pediatricians to screen for social determinants of health. Our prior efficacy trial demonstrated that a pediatric-based intervention 'WE CARE' increased parental receipt of community resources," Ariel Porto, from the Boston University School of Medicine, and colleagues wrote. "However, the impact of implementing universal social determinants of health screening and referral in a real-world pediatric clinical setting remains unknown."

To provide universal screening and referral for families with material needs, including child care and food, at child well-care visits, the researchers implemented an intervention focused on social determinants of health called WE CARE. This quality improvement intervention was implemented in an urban pediatric primary care clinic between July 2016 to July 2017, and consecutive plan-do-study-act cycles were performed by a multidisciplinary team.

Screening for this program was conducted by front desk personnel who were trained to provide this assessment for children between the ages of 0 and 11 years at well-child care visits. Training was also provided to medical assistants who were responsible for entering data into flowsheets located in electronic medical records and to pediatricians who offered resource information sheets relevant to their community. A total of six unmet needs were screened for, including child care, education to high school or an equivalent, employment, food, household heat and homelessness.

Once data were collected in electronic medical records, Porto and colleagues reviewed charts before and after the implementation of WE CARE and information from the screeners. Furthermore, the researchers expressed the process of identification and referral over time using statistical process control charts and descriptive statistics.

During baseline, 673 families were screened. Of these families, 1% reported that they had a need that was unmet. Less than 1% of these families were referred to resources in their community that could assist in meeting these needs, as reported in electronic medical records.

Once the study period began, the researchers observed data from 2,765 well-child care visits in 52 weeks.  Within this time, 52% of families screened asked for help regarding unmet needs (weekly range: 0%-90%), with the most frequently reported unmet needs being employment (26%), child care (24%), utilities (18%), education (14%), food (10%) and shelter (7%). When these requests were made, pediatricians appropriately referred more than 50% of families that visited the clinic when individual weekly feedback was received (weekly range: 27%-88%).

"The implementation of WE CARE was feasible in an urban pediatric clinic and significantly increased pediatrician identification of adverse social determinants of health and referrals to community resources for families at well-child care visits," Porto and colleagues wrote. "Further work, however, is needed to ensure that families receive services from requested referrals." –by Katherine Bortz

References:

Porto A, et al. Improving pediatricians’ identification of and referrals for adverse social determinants of health at well-child care visits. Board 356. Presented at: The Pediatric Academic Societies 2018 Meeting; May 5-8, 208; Toronto.