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Assaf RR, Assaf RD, Padlipsky PS, Young KDA. A family-centered approach to social needs awareness in the pediatric emergency department. PEC INNOVATION 2024; 4:100283. [PMID: 38689830 PMCID: PMC11059452 DOI: 10.1016/j.pecinn.2024.100283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/01/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
Objective We aimed to understand family preferences around reporting and receiving health-related social needs (HRSN) information by assessment modality during pediatric emergency department (PED) visits. Methods Families were randomized into paper (control), cell phone, or tablet modality groups by their child's exam room. Nurses alerted families to complete a single HRSN assessment during routine workflow. We used logistic regression and McNemar's test to assess discordance in modality preference. Results Forty-seven percent of families disclosed at least one HRSN across a total 611 assessments. Disclosure of HRSN was similar by modality. Twenty-three percent of those assigned tablet preferred cell phone (p < 0.001). Two-thirds of families preferred receiving digitally formatted community resources (email or text). There was no difference in preferred timing of HRSN assessment completion. Conclusions Assessment modality did not appear to influence family HRSN disclosure. Families were generally satisfied with all HRSN assessment modalities but demonstrated a particular preference in using personal cell phones over tablets. Digitally formatted community referrals also pose numerous advantages over conventional paper handouts. Innovation Use of personal cell phones is a novel, streamlined method of HRSN interventions in the clinical setting, performing similar to more conventional modalities, with a preference among families when compared to tablets.
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Affiliation(s)
- Raymen Rammy Assaf
- Emergency Medicine Specialists of Orange County, Children's Hospital Orange County, Orange, USA
- Department of Pediatrics, University of California, Irvine (UCI) School of Medicine, Irvine, USA
| | - Ryan David Assaf
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, USA
| | - Patricia Sencer Padlipsky
- Department of Emergency Medicine, Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, USA
| | - Kelly Dee Ann Young
- Department of Emergency Medicine, Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, USA
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Cordova-Ramos EG, Burke J, Sileo N, McGean M, Torrice V, Mantri S, Parker MG, Drainoni ML. "We Don't Want to Screen for the Sake of Screening": A Qualitative Evaluation of a Social Needs Screening and Referral Intervention in the NICU. J Perinat Neonatal Nurs 2024; 38:271-279. [PMID: 37773583 PMCID: PMC10972769 DOI: 10.1097/jpn.0000000000000766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
BACKGROUND Low uptake of social determinants of health (SDH) screening and referral interventions within neonatal intensive care units (NICUs) is partly due to limited understanding of the best procedures to integrate this practice into routine clinical workflows. PURPOSE To examine the feasibility and acceptability of an SDH screening and referral intervention in the NICU from the perspective of neonatal nurses; and to identify factors affecting implementation outcomes. METHODS We conducted 25 semistructured interviews with NICU nurses. We used the Promoting Action on Research Implementation in Health Services (PARiHS) framework to guide interview questions and codebook development for directed content analysis. Themes were mapped onto the 3 PARiHS domains of context, evidence, and facilitation. FINDINGS Analysis yielded 8 themes. Context : Nurses felt that stressors experienced by NICU families are magnified in a safety net environment. Nurses shared varying viewpoints of the roles and responsibilities for social care in the NICU, and feared that scarcity of community resources would make it difficult to address families' needs. Evidence : The intervention was perceived to increase identification of adverse SDH and provision of resources; and to potentially jump-start better caregiver and infant health trajectories. Facilitation : Procedures that improved acceptability included dynamic training and champion support, regular feedback on intervention outcomes, and strategies to reduce stigma and bias. CONCLUSION We identified contextual factors, concrete messaging, and training procedures that may inform implementation of SDH screening and referral in NICU settings.
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Affiliation(s)
- Erika G. Cordova-Ramos
- Boston Medical Center, Department of Pediatrics, Boston, MA
- Evans Center for Implementation and Improvement Sciences (CIIS), Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Judith Burke
- Boston Medical Center, Department of Pediatrics, Boston, MA
| | - Nicole Sileo
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Maggie McGean
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Vanessa Torrice
- Children’s Hospital at Montefiore, Department of Pediatrics, Bronx, NY
| | - Saaz Mantri
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | | | - Mari-Lynn Drainoni
- Evans Center for Implementation and Improvement Sciences (CIIS), Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
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3
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Johansson N, Warner G, Avogadri N, Sarkadi A. Screening for economic hardship at Child Health Care Centres: A qualitative study of stakeholders' perceptions and experiences of the Healthier Wealthier Families model in Sweden. Scand J Public Health 2024:14034948241252227. [PMID: 38813674 DOI: 10.1177/14034948241252227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
AIMS The Healthier Wealthier Families model uses the child healthcare services as an access point to screen and connect parents experiencing economic hardship to municipal Budget and Debt Counselling services. This study aimed to explore the perceptions and experiences of the Healthier Wealthier Families model in a Swedish context. METHODS Semi-structured interviews were conducted with three stakeholder groups: eligible parents who declined (n=10) and received (n=9) financial counselling; nurses (n=7); and financial counsellors (n=5). The data were analysed using thematic analysis. RESULTS The analysis resulted in three main themes conveying the stigma of talking about finance, the connection between economic situation and family wellbeing, and the nuts and bolts of providing preventive financial counselling. CONCLUSIONS A working model aiming to ameliorate child poverty in a societal service context needs to address the preconceptions and perceived mandate and role of the professionals, the prevalence of financial stigma in society, especially in relation to being a 'good' parent, and the current preoccupations and perceived financial needs and hopes of the families served.
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Affiliation(s)
- Nina Johansson
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Georgina Warner
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Nils Avogadri
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Anna Sarkadi
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
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Starling CM, Smith M, Kazi S, Milicia A, Grisham R, Gruber E, Blumenthal J, Arem H. Understanding social needs screening and demographic data collection in primary care practices serving Maryland Medicare patients. BMC Health Serv Res 2024; 24:448. [PMID: 38600578 PMCID: PMC11005183 DOI: 10.1186/s12913-024-10948-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Health outcomes are strongly impacted by social determinants of health, including social risk factors and patient demographics, due to structural inequities and discrimination. Primary care is viewed as a potential medical setting to assess and address individual health-related social needs and to collect detailed patient demographics to assess and advance health equity, but limited literature evaluates such processes. METHODS We conducted an analysis of cross-sectional survey data collected from n = 507 Maryland Primary Care Program (MDPCP) practices through Care Transformation Requirements (CTR) reporting in 2022. Descriptive statistics were used to summarize practice responses on social needs screening and demographic data collection. A stepwise regression analysis was conducted to determine factors predicting screening of all vs. a targeted subset of beneficiaries for unmet social needs. RESULTS Almost all practices (99%) reported conducting some form of social needs screening and demographic data collection. Practices reported variation in what screening tools or demographic questions were employed, frequency of screening, and how information was used. More than 75% of practices reported prioritizing transportation, food insecurity, housing instability, financial resource strain, and social isolation. CONCLUSIONS Within the MDPCP program there was widespread implementation of social needs screenings and demographic data collection. However, there was room for additional supports in addressing some challenging social needs and increasing detailed demographics. Further research is needed to understand any adjustments to clinical care in response to identified social needs or application of data for uses such as assessing progress towards health equity and the subsequent impact on clinical care and health outcomes.
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Affiliation(s)
- Claire M Starling
- Implementation Science, Healthcare Delivery Research Program, MedStar Health Research Institute, 6525 Belcrest Road, Suite 700, Hyattsville, MD, 20782, USA.
| | - Marjanna Smith
- Implementation Science, Healthcare Delivery Research Program, MedStar Health Research Institute, 6525 Belcrest Road, Suite 700, Hyattsville, MD, 20782, USA
| | - Sadaf Kazi
- Department of Emergency Medicine, Georgetown University School of Medicine, 3900 Reservoir Road, Washington, NWDC, 20007, USA
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, 3007 Tilden St.Suite 6N, Washington, NWDC, 20008, USA
| | - Arianna Milicia
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, 3007 Tilden St.Suite 6N, Washington, NWDC, 20008, USA
| | - Rachel Grisham
- Maryland Primary Care Program, Maryland Department of Health, 201 W. Preston Street, Baltimore, MD, 21201, USA
| | - Emily Gruber
- Maryland Primary Care Program, Maryland Department of Health, 201 W. Preston Street, Baltimore, MD, 21201, USA
| | - Joseph Blumenthal
- MedStar Center for Biostatistics, Informatics and Data Science, MedStar Health Research Institute, 3007 Tilden St.Suite 6N, Washington, NWDC, 20008, USA
| | - Hannah Arem
- Implementation Science, Healthcare Delivery Research Program, MedStar Health Research Institute, 6525 Belcrest Road, Suite 700, Hyattsville, MD, 20782, USA
- Department of Oncology, Georgetown University School of Medicine, 3900 Reservoir Road, Washington, NWDC, 20007, USA
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Karvonen KA, Umaretiya PJ, Koch VB, Flamand Y, Aziz-Bose R, Ilcisin L, Valenzuela A, Cole PD, Gennarini LM, Kahn JM, Kelly KM, Tran TH, Michon B, Welch JJ, Wolfe J, Silverman LB, Rosenberg AR, Bona K. Inequitable Poverty Exposures: A Subspecialty Opportunity to Address Disparities. Hosp Pediatr 2024; 14:e104-e106. [PMID: 38239110 PMCID: PMC10823182 DOI: 10.1542/hpeds.2023-007482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Affiliation(s)
- Kristine A. Karvonen
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
- Seattle Children’s Research Institute, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | - Yael Flamand
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rahela Aziz-Bose
- Department of Pediatric Oncology
- Division of Population Sciences
- Division of Pediatric Hematology/Oncology
- Harvard Medical School, Boston, Massachusetts
| | - Lenka Ilcisin
- Department of Pediatric Oncology
- Department of Surgery, Boston Children’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Peter D. Cole
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | | | - Justine M. Kahn
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Medical Center, New York, New York
| | - Kara M. Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
- Division of Pediatric Hematology/Oncology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Thai Hoa Tran
- Division of Pediatric Hematology Oncology, Charles-Bruneau Cancer Center, CHU Ste-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Bruno Michon
- Centre Hospitalier Universitaire de Quebec, Saint-Foy, Quebec, Canada
| | - Jennifer J.G. Welch
- Division of Pediatric Hematology/Oncology, Hasbro Children’s Hospital, Brown University, Providence, Rhode Island
| | - Joanne Wolfe
- Harvard Medical School, Boston, Massachusetts
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Lewis B. Silverman
- Department of Pediatric Oncology
- Division of Pediatric Hematology/Oncology
- Harvard Medical School, Boston, Massachusetts
| | - Abby R. Rosenberg
- Division of Pediatric Hematology/Oncology
- Harvard Medical School, Boston, Massachusetts
| | - Kira Bona
- Department of Pediatric Oncology
- Division of Population Sciences
- Division of Pediatric Hematology/Oncology
- Harvard Medical School, Boston, Massachusetts
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Wood EB, Brown A, Douglas CS, Lawrence J, Wotherspoon Z, Gollenberg A. Engaging Emergency Nurses in Strategies to Address the Social Determinants of Health. J Emerg Nurs 2024; 50:145-152. [PMID: 37552150 DOI: 10.1016/j.jen.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION For patients with social needs, emergency departments can be an essential bridge between the health care system and the community. Emergency nurses' knowledge of and engagement in this work need to be examined to ensure that efforts for social determinants of health screening and the resulting community connections are effective. However, there is limited research in this area of nursing practice. The purpose of this study is to describe emergency nurses' knowledge about social needs in their community, assess their knowledge of existing community resources, and examine their perceived confidence to respond to the social needs of their patients. METHODS A cross-sectional survey was conducted with 243 nurses employed in a large regional health care system. Data were collected using an adapted 81-item social determinants of health survey instrument to measure knowledge of social determinants of health, confidence, and frequency of discussing social determinants of health with emergency department patients and awareness of social resources available in the community. Survey participants were asked about barriers to incorporating social determinants of health into their emergency department workflow and to provide general demographic information. Descriptive statistics were used to analyze study results. RESULTS Most of the 243 emergency nurse participants believed that addressing social determinants of health was important and that emergency nurses should be involved in issues around social determinants of health. However, most nurses reported limited knowledge about social determinants of health and had very limited knowledge about the resources available in their community to help patients with needs related to food, housing, medical care, and transportation. Nurses reported that although they know that their patients are unlikely to ask for help with social needs during an emergency department visit, they are still unlikely to ask their patients about social needs owing to low confidence about having social needs conversations, limited time, and competing care priorities. Participants advocated for greater case manager presence. Feeling connected to the community was significantly correlated to increased knowledge, confidence, and likelihood to ask about social needs (P < .05). DISCUSSION The emergency department is a logical place for screening for social determinants of health and connecting patients with social needs to community resources. Emergency nurses included in this study acknowledged that they want to address the social needs of their patients but reported that they lack knowledge about both social determinants of health and more importantly about the resources available to help patients with social needs. In general, they did not feel confident discussing social determinants of health with their patients in the emergency department and are unlikely to ask about social needs. Barriers to screening include time, competing care priorities, and lack of knowledge and support needed from case managers. Findings from this study have implications for supporting emergency nurses employed in institutions that seek to address social influences of health for the patients in their communities.
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DeCamp LR, Yousuf S, Peters C, Cruze E, Kutchman E. Assessing Strengths, Challenges, and Equity Via Pragmatic Evaluation of a Social Care Program. Acad Pediatr 2024; 24:23-32. [PMID: 37024078 DOI: 10.1016/j.acap.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/21/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE Models of pragmatic social care program evaluations are needed as many are clinical services programs and are not focused on research, limiting the ability to address key evidence gaps. We describe the use of the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to conduct a pragmatic evaluation of a pediatric ambulatory social care program. METHODS Our evaluation was based on automated electronic health record data on clinics, community partners, social care program processes, and social needs screen data linked to patient sociodemographic characteristics from February 2020 to September 2021. Two Reach outcomes were assessed: 1) the proportion of eligible patients that completed social needs screening and 2) the proportion of positive screens that receive social care program follow-up. The Effectiveness outcome was meeting families' resource need(s). RESULTS Reach among eligible patients who completed screening was 79.2%. Reach for positive screens receiving social care program referrals demonstrated a higher proportion of referrals among patients with a preferred healthcare language (PHL) of Spanish (45.1%) compared to English (31.2%, P < .001). Effectiveness analyses demonstrated that overall, 75.1% of social care program referrals had all social resource needs met, 17.5% had some needs met, and 7.4% had no needs met. The percent of patients with all resource needs met was higher for patients with PHL of Spanish or Non-English, Non-Spanish (79% for each respectively) compared to English (73%, P = .023). CONCLUSIONS Maximizing automated data collection is likely the most feasible way for social care programs to complete evaluation activities outside of the research context.
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Affiliation(s)
- Lisa Ross DeCamp
- Children's Hospital Colorado (LR DeCamp, S Yousuf, C Peters, E Cruze, and E Kutchman), Aurora; Department of Pediatrics (LR DeCamp), University of Colorado School of Medicine, Aurora; Adult and Child Center for Outcomes Research and Delivery Science (LR DeCamp), Aurora, Colo.
| | - Sana Yousuf
- Children's Hospital Colorado (LR DeCamp, S Yousuf, C Peters, E Cruze, and E Kutchman), Aurora.
| | - Claire Peters
- Children's Hospital Colorado (LR DeCamp, S Yousuf, C Peters, E Cruze, and E Kutchman), Aurora.
| | - Ellen Cruze
- Children's Hospital Colorado (LR DeCamp, S Yousuf, C Peters, E Cruze, and E Kutchman), Aurora.
| | - Eve Kutchman
- Children's Hospital Colorado (LR DeCamp, S Yousuf, C Peters, E Cruze, and E Kutchman), Aurora.
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Akande M, Paquette ET, Magee P, Perry-Eaddy MA, Fink EL, Slain KN. Screening for Social Determinants of Health in the Pediatric Intensive Care Unit: Recommendations for Clinicians. Crit Care Clin 2023; 39:341-355. [PMID: 36898778 PMCID: PMC10332174 DOI: 10.1016/j.ccc.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Social determinants of health (SDoH) play a significant role in the health and well-being of children in the United States. Disparities in the risk and outcomes of critical illness have been extensively documented but are yet to be fully explored through the lens of SDoH. In this review, we provide justification for routine SDoH screening as a critical first step toward understanding the causes of, and effectively addressing health disparities affecting critically ill children. Second, we summarize important aspects of SDoH screening that need to be considered before implementing this practice in the pediatric critical care setting.
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Affiliation(s)
- Manzilat Akande
- Section of Critical Care, Department of Pediatrics, Oklahoma University Health Sciences Center, OU Children's Physicians Building, 1200 Children's Avenue, Oklahoma City, OK 73104, USA.
| | - Erin T Paquette
- Division of Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East, Chicago Avenue, Box 73, Chicago, IL 60611, USA
| | - Paula Magee
- Division of Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East, Chicago Avenue, Box 73, Chicago, IL 60611, USA
| | - Mallory A Perry-Eaddy
- University of Connecticut School of Nursing, 231 Glenbrook Rd, U-4026, Storrs, CT 06269, USA; Department of Pediatrics, University of Connecticut School of Medicine, 200 Academic Way, Farmington, CT 06032, USA
| | - Ericka L Fink
- Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 2nd floor, Pittsburgh, PA 15206, USA
| | - Katherine N Slain
- Division of Pediatric Critical Care Medicine, University Hospitals Rainbow Babies & Children's Hospital, 11100 Euclid Avenue, RBC 6010 Cleveland, OH 44106, USA; Department of Pediatrics, Case Western Reserve University School of Medicine, 9501 Euclid Avenue, Cleveland, OH 44106, USA
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Abstract
PURPOSE OF REVIEW This article outlines updates in social determinants of health (SDOH) screening practices in pediatric healthcare and community settings. The transition to value-based care and the COVID-19 pandemic have both had significant impacts on screening practices, with implications for providers, communities, and policymakers. RECENT FINDINGS The COVID-19 pandemic has exacerbated social needs for vulnerable patients and families, resulting in increased recognition by healthcare teams through screening. Policy frameworks like value-based care that aim to deliver whole-child care in the community are reorienting the logistics of screening, including screening in acute-care settings and community settings. Recent studies on family and provider perspectives should be integrated into screening practices. SUMMARY Despite significant advances in and expansion of SDOH screening in the pediatric healthcare setting, there remain limitations and future research needs. More data is needed to evaluate social need screeners and interventions, and determine how healthcare systems, communities, and states can spread and scale such interventions based on outcomes and value measurements. Population-based social indices have the potential to augment individual patient screening, but this remains a future research need.
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Affiliation(s)
- Abby L Nerlinger
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
- Nemours Children's Hospital, Delaware, Wilmington, Delaware
| | - Gift Kopsombut
- University of Central Florida
- Nemours Children's Hospital, Florida, Orlando, Florida, USA
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Giorgi EM, Drescher MJ, Winkelmann ZK, Eberman LE. Validation of a Script to Facilitate Social Determinant of Health Conversations with Adolescent Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192214810. [PMID: 36429530 PMCID: PMC9690555 DOI: 10.3390/ijerph192214810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 05/13/2023]
Abstract
Current social determinants of health (SDOH) tools exist to assess patient exposure; however, healthcare providers for the adolescent population are unsure of how to integrate SDOH knowledge into clinical practice. The purpose of this study was to validate a focused history script designed to facilitate SDOH conversations between clinicians and adolescents through the use of the Delphi method. Six individuals (1 clinician, 5 educators/researchers) participated as expert panelists. Panelists provided critical feedback on the script for rounds 1 and 2. For rounds 3-7, panelists received an electronic questionnaire asking them to indicate agreement on a 6-point Likert scale (1 = strongly disagree, 6 = strongly agree). We defined consensus as mean item agreement ≥ 5.0 and percent agreement ≥ 80%. In round 7, panelists rated overall script level of agreement. After seven rounds of feedback, the focused history script achieved content validity with 100% of panelists agreeing on the final 40-item script. A focused history script for the SDOH was content validated to aid conversations between healthcare providers and adolescent patients on factors that affect their life, school, and play. Addressing social determinants of health with adolescent patients will improve cultural proficiency and family-centered care delivered by school healthcare professionals.
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Affiliation(s)
- Emily M. Giorgi
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN 47803, USA
- Correspondence: ; Tel.: +1-916-822-1338
| | - Matthew J. Drescher
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN 47803, USA
| | - Zachary K. Winkelmann
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
| | - Lindsey E. Eberman
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN 47803, USA
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11
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Lopez KN, Fuentes-Afflick E. Engaging Pediatric Subspecialists in Pursuit of Health Equity-Breaking Out of the Silo. JAMA Pediatr 2022; 176:841-842. [PMID: 35849417 DOI: 10.1001/jamapediatrics.2022.2420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Keila N Lopez
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Elena Fuentes-Afflick
- Department of Pediatrics, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco
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12
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Davis K, Fair ML, Buckingham C, McKinnon H, Theriot Roley L, Sease K. Impacts of a medical-legal partnership on clinical capacity to address social determinants of health. J Epidemiol Community Health 2022; 76:jech-2022-219270. [PMID: 36028307 DOI: 10.1136/jech-2022-219270] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/11/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Social determinants of health (SDOHs) impacts on an individual's health outcomes have become more evident, and clinical providers are vital in helping patients address those needs. Providers are experiencing high-stress levels related to patient care, resulting in a diminished capacity to address these SDOHs. This study examines the impact of a medical-legal partnership (MLP) on the clinical capacity to assist providers with addressing SDOH needs and reducing clinician stress. METHODS A 16-question survey was emailed to 532 providers in a local health system. The survey assessed clinicians' perception of their role in addressing SDOH needs, the MLP's impact on their clinical capacity and the MLP's ability to remedy patient SDOH needs. RESULTS Providers who have referred to the MLP indicated higher levels of agreement that SDOH screenings were part of their clinical responsibility and had higher levels of agreement regarding comfort levels for completing SDOH screenings. Geriatric providers reported higher levels of agreement that the MLP reduced clinician stress than paediatric providers. CONCLUSION MLPs have the potential to reduce clinician stress and burnout by standing in the gap to assist providers in addressing their patient's SDOH needs.
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Affiliation(s)
- Kara Davis
- Institute for the Advancement of Community Health, Furman University, Greenville, South Carolina, USA
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - Melissa L Fair
- Institute for the Advancement of Community Health, Furman University, Greenville, South Carolina, USA
| | - Catie Buckingham
- Institute for the Advancement of Community Health, Furman University, Greenville, South Carolina, USA
- Department of Population, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hannah McKinnon
- Institute for the Advancement of Community Health, Furman University, Greenville, South Carolina, USA
| | | | - Kerry Sease
- Children's Hospital, Prisma Health, Greenville, South Carolina, USA
- University of South Carolina School of Medicine, Greenville, South Carolina, USA
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13
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Assaf RR, Assaf RD, Barber Doucet H, Graff D. Pediatric emergency department organization and social care practices among U.S. fellowship programs. AEM EDUCATION AND TRAINING 2022; 6:AET210791. [PMID: 35982713 PMCID: PMC9366751 DOI: 10.1002/aet2.10791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/26/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Background Social care has become increasingly relevant to the emergency physician and includes activities that address health-related social risk and social needs. The literature has consistently documented substantial health care provider challenges in incorporating social care into routine practice. Yet, interventions on the health care organizational level hold promise to bring about more widespread, sustainable impact. Methods This study was a subanalysis of the 2021 National Social Care Practices Survey data set among pediatric emergency medicine (PEM) program directors (PDs) and fellows. The purpose was to investigate the association between health care organizational factors and PEM physician social care practices and perceptions among PEM PDs and fellows. We performed binary and ordinal logistic regressions of organizational factors and five specific PEM physician social care perspective and practice outcomes. Results The sample population included 153 physicians-44 PDs (49% response rate) and 109 fellows (28%). PDs and fellows with access to a social care systematic workflow in their pediatric emergency department (PED) had higher odds of comfort assessing social risk (odds ratio [OR] 2.1%, 95% confidence interval [CI] 1.1-4.0), valuation of social care (OR 3.2, 95% CI 1.3-7.9), preparedness to assist families (OR 2.4, 95% CI 1.1-5.2), screening tendency (OR 2.2, 95% CI 1.1-4.5), and ability to refer to community resources (OR 2.3, 95% CI 1.2-4.6). A similarly directed, but less pronounced pattern was noted with access to a community resource database for referrals and 24-h access to a social worker in the PED. Conclusions PED organizational factors-particularly access to a social care systematic workflow-appear positively associated with PEM physician practices and perceptions of social care delivery. Further research is under way to advance understanding of PEM training factors in social care.
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Affiliation(s)
- Raymen Rammy Assaf
- Harbor University of California Los Angeles (UCLA) Medical CenterLos AngelesCaliforniaUSA
| | | | - Hannah Barber Doucet
- Hasbro Children's HospitalAlpert Medical School at Brown UniversityProvidenceRhode IslandUSA
| | - Danielle Graff
- Norton Children's HospitalUniversity of Louisville, School of MedicineLouisvilleKentuckyUSA
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Assaf RR, Barber Doucet H, Assaf R, Graff D. Social care practices and perspectives among U.S. pediatric emergency medicine fellowship programs. AEM EDUCATION AND TRAINING 2022; 6:e10737. [PMID: 35493290 PMCID: PMC9045575 DOI: 10.1002/aet2.10737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The emergence of social emergency medicine-the incorporation of social context into the structure and practice of emergency care-has brought forth greater embracement of the social determinants of health by medical professionals, yet workforce practices and training have remained elusive. Academic literature particularly in the field of pediatric emergency medicine (PEM) fellowship training is lacking relative to general pediatrics and adult emergency medicine. METHODS The primary objective of this study was to assess the social care knowledge, perspectives, and training of PEM program directors (PDs) and fellows across a national cross-sectional sample. A secondary aim was to uncover key actionable areas for the development of social care curricula in PEM training programs. A social care practices assessment tool was developed via snowball sampling interviews among clinician researcher experts and disseminated to PEM PDs and fellows nationally in accredited academic PEM training institutions. RESULTS A total of 153 participants-44 PDs (49% response rate) and 109 fellows (28%)-completed the assessment tool. Responses among PDs and fellows were highly concordant. Only 12% reported regular use of a standardized social needs screening tool. The majority felt unprepared to assist families with social needs and less than half felt comfortable talking to families about social need. At the same time, social care was highly valued by 73% of participants. All participants felt that providing social care training during PEM fellowship would be beneficial. PDs and fellows identified five priority areas for PEM curricular development. CONCLUSIONS PEM PDs and fellows have an overall favorable perception of social care yet report significant deficits in current practice organization and training. This study is part of a larger national collaborative advocacy project to organize and advance social care delivery across academic PEM training institutions through evidence-based approaches, best practices, and expert consensus.
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Affiliation(s)
- Raymen Rammy Assaf
- Harbor University of California Los Angeles (UCLA) Medical CenterTorranceCaliforniaUSA
| | - Hannah Barber Doucet
- Hasbro Children’s HospitalAlpert Medical School at Brown UniversityProvidenceRhode IslandUSA
| | | | - Danielle Graff
- School of MedicineNorton Children’s HospitalUniversity of LouisvilleLouisvilleKentuckyUSA
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