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Fico P, Atwood S, Arbour M. Beyond 'Screen & Refer': Understanding Families' Use of Resources for Health-related Social Needs Identified via Primary Care. Acad Pediatr 2024:S1876-2859(24)00237-7. [PMID: 38950731 DOI: 10.1016/j.acap.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 06/12/2024] [Accepted: 06/23/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVE As health-related social needs (HRSN) screening increases, attention to families' resource preferences lags. This study of a pediatric primary care intervention (DULCE) with reliable HRSN screening and resource connection explored whether resources adequately addressed families' needs and, when HRSN persisted, families' reasons for declining resources. METHODS This retrospective cohort, mixed-methods study analyzed data from 989 families that received care at seven pediatric clinics implementing DULCE in three states. DULCE screens for seven HRSN around the 1-month and 4-month well-child visits; we calculated the percent of initial and ongoing positive screens. For positive rescreens, we calculated the percent that had all eligible or wanted resources and that were interested in further resources. We also analyzed case notes, which elicited families' resource preferences, and explored demographic characteristics associated with ongoing HRSN. RESULTS Half of enrolled families (508 of 989) initially screened positive for HRSN; 124 families had positive rescreens; 26 expressed interest in further assistance. Most families with ongoing concrete supports needs accessed all eligible resources (60-100%); 20-58% had everything they wanted. Fewer families with ongoing maternal depression and intimate partner violence accessed all eligible resources (48% and 18%, respectively); most reported having all wanted resources (76% and 90%, respectively). Families declined resources due to lack of perceived need, the HRSN resolving, or families addressed HRSN themselves. White families were more likely to rescreen positive. CONCLUSIONS Pediatric medical homes must honor family-centered decision-making while empowering families to accept beneficial resources. Healthcare systems should advocate for resources that families need and want.
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Affiliation(s)
- Placidina Fico
- Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA
| | - Sidney Atwood
- Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA
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Poole CL, Hutson Chatham A, Kimberlin DW, Hartzes A, Brown J. Water and Sanitation Access for Children in Alabama. Pediatrics 2024; 153:e2023063981. [PMID: 38690625 DOI: 10.1542/peds.2023-063981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Safe drinking water and closed sanitation are fundamental to health and are assumed in the United States, however, gaps remain, disproportionately affecting marginalized communities. We sought to describe household sanitation access for children in rural Alabama and local health provider knowledge of sanitation related health concerns. METHODS Data were collected from self-administered surveys obtained from children enrolled in a larger cross-sectional study to determine soil transmitted helminthiasis prevalence in Alabama, from a survey of health providers from local federally qualified health centers and from a baseline knowledge check of Alabama health providers enrolled in an online sanitation health course. RESULTS Surveys completed on 771 children (approximately 10% of county pediatric population) revealed less than half lived in homes connected to centralized sewers; 12% reported "straight-pipes," a method of discharging untreated sewage to the ground outside the home, and 8% reported sewage contamination of their home property in the past year. Additionally, 15% of respondents were likely to use well water. The local health providers surveyed did not include routine screening for water and sanitation failures or associated infections. Regional healthcare providers have limited knowledge of soil transmitted helminthiasis. CONCLUSIONS A significant number of children from rural counties of Alabama with high rates of poverty reside in homes with water and sanitation challenges that predominantly affect African American families. This is an under-recognized health risk by local health providers, and its contribution to well-documented health disparities in this region is poorly understood.
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Affiliation(s)
| | | | | | | | - Joe Brown
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Monahan E, McCrae JS, Arbour M. Participation in Pediatric Primary Care Innovation, DULCE, Increases Caregiver Agency and Resilience and Decreases Impact of Stress. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:685-698. [PMID: 37917335 DOI: 10.1007/s11121-023-01608-z] [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] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
The purpose of the present study was to explore outcomes and heterogeneous effects of an evidence-based, cross-sector pediatric healthcare intervention for families with infants, Developmental Understanding and Legal Collaboration for Everyone (DULCE). DULCE is tailored to allow families' needs and desires to drive DULCE intensity. This is a longitudinal study following families involved with pediatric primary care clinics from infant's birth to 15 months. Multi-level longitudinal modeling was used to compare the program's influence on resilience, parent agency, and the impact of stress on parent functioning among program recipients (n = 172) and non-recipients (n = 170). Study participants were recruited from four health care clinics in California and Florida, and participants completed in-person survey interviews at baseline (infant age 0-6 months) and final (infant age 12-15 months) timepoints, with a minimum of 6 months between baseline and final interview required. Assignment of families to intervention (participated in DULCE) or comparison group (received clinic care as usual) varied by clinic. The cross-sector pediatric primary care intervention screened families at high rates (70-90%), along with referring and connecting families to resources. DULCE participation was associated with increases in parents' agency and resilience. DULCE's positive influence on parent agency and impact of stress was observed with low dosage, and higher-risk families saw additional improvements in resilience at high dosage (high and low risk defined with Latent Profile Analysis). Findings reinforce the importance of examining heterogeneous effects of evidence-based interventions. DULCE's influence on parent agency and impact of stress was observed with low dosage; strengthened resilience among higher-risk families was found at high dosage. These findings document the value of a universal approach to prevention services in pediatric settings with tailoring that allows families to drive their engagement with the intervention.
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Affiliation(s)
- Emma Monahan
- Chapin Hall, University of Chicago, Chicago, IL, USA.
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Dumitriu D, Lavallée A, Riggs JL, Frosch CA, Barker TV, Best DL, Blasingame B, Bushar J, Charlot-Swilley D, Erickson E, Finkel MA, Fortune B, Gillen L, Martinez M, Ramachandran U, Sanders LM, Willis DW, Shearman N. Advancing early relational health: a collaborative exploration of a research agenda. Front Pediatr 2023; 11:1259022. [PMID: 38143537 PMCID: PMC10748603 DOI: 10.3389/fped.2023.1259022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/07/2023] [Indexed: 12/26/2023] Open
Abstract
Here, we introduce the Early Relational Health (ERH) Learning Community's bold, large-scale, collaborative, data-driven and practice-informed research agenda focused on furthering our mechanistic understanding of ERH and identifying feasible and effective practices for making ERH promotion a routine and integrated component of pediatric primary care. The ERH Learning Community, formed by a team of parent/caregiver leaders, pediatric care clinicians, researchers, and early childhood development specialists, is a workgroup of Nurture Connection-a hub geared toward promoting ERH, i.e., the positive and nurturing relationship between young children and their parent(s)/caregiver(s), in families and communities nationwide. In response to the current child mental health crisis and the American Academy of Pediatrics (AAP) policy statement promoting ERH, the ERH Learning Community held an in-person meeting at the AAP national headquarters in December 2022 where members collaboratively designed an integrated research agenda to advance ERH. This agenda weaves together community partners, clinicians, and academics, melding the principles of participatory engagement and human-centered design, such as early engagement, co-design, iterative feedback, and cultural humility. Here, we present gaps in the ERH literature that prompted this initiative and the co-design activity that led to this novel and iterative community-focused research agenda, with parents/caregivers at the core, and in close collaboration with pediatric clinicians for real-world promotion of ERH in the pediatric primary care setting.
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Affiliation(s)
- Dani Dumitriu
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, United States
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Andréane Lavallée
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, United States
| | - Jessica L. Riggs
- Department of Psychiatry, The University of Michigan, Ann Arbor, MI, United States
| | - Cynthia A. Frosch
- Department of Human Development and Family Science, Auburn University, Auburn, AL, United States
| | - Tyson V. Barker
- Science and Innovation Strategy, Institute for Child Success, Greenville, SC, United States
| | - Debra L. Best
- Department of Pediatrics, Division of General Pediatrics and Adolescent Health, Duke University School of Medicine, Durham, NC, United States
| | | | - Jessica Bushar
- HealthySteps, ZERO TO THREE, Washington, DC, United States
| | | | - Elizabeth Erickson
- Department of Pediatrics, Division of General Pediatrics and Adolescent Health, Duke University School of Medicine, Durham, NC, United States
| | - Morgan A. Finkel
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, United States
| | - Bryn Fortune
- Fortune Consulting, Early Relational Health-Family Network Collaborative, Royal Oak, MI, United States
| | - Leah Gillen
- Department of Research and Innovation, Reach out and Read, Boston, MA, United States
| | - Marty Martinez
- Chief Executive Officer, Reach Out and Read, Boston, MA, United States
| | - Usha Ramachandran
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, United States
| | - Lee M. Sanders
- Department of Pediatrics, Division of General Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - David W. Willis
- Center for the Study of Social Policy, Washington, DC, United States
| | - Nikki Shearman
- Department of Research and Innovation, Reach out and Read, Boston, MA, United States
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Chavez LJ, Tyson DP, Davenport MA, Kelleher KJ, Chisolm DJ. Social Needs as a Risk Factor for Positive Postpartum Depression Screens in Pediatric Primary Care. Acad Pediatr 2023; 23:1411-1416. [PMID: 36958532 DOI: 10.1016/j.acap.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE The goal of this study was to examine the association between self-reported social needs and postpartum depression (PPD) symptoms of mothers screened in pediatric primary care clinics. METHODS This retrospective cohort study used electronic health record data from 3616 pediatric patients (age 0-6 months), whose mothers completed the Edinburgh Postpartum Depression Scale (EPDS) and a social needs screening in a large pediatric primary care network between April 2021 and February 2022. Mothers were screened for four self-reported social needs (food, housing, transportation, and utilities). Logistic regression evaluated the association between the report of any social need and a positive EPDS screen (≥ 10), adjusting for demographic and clinical characteristics and ZIP code-level poverty. RESULTS Overall, 8.6% of mothers screened positive for PPD and 10.0% reported any social needs. The odds of a positive depression screen were significantly higher among mothers who reported any social need compared to those not reporting a social need (OR 4.18, 95% CI 3.11-5.61). The prevalence of all depressive symptoms on the EPDS was significantly higher among those who reported any social need, relative to those reporting no needs. Mothers reporting any social needs were significantly more likely to report thoughts of self-harm (6.9% vs 1.5%, P < .005). CONCLUSIONS Self-report of social need was significantly associated with positive PPD screens during infant well-child visits. Social needs may be a target of future interventions addressing PPD in pediatric settings. Improving care for social needs may have added benefit of alleviating the risk of PPD.
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Affiliation(s)
- Laura J Chavez
- Center for Child Health Equity and Outcomes Research (LJ Chavez, MA Davenport, KJ Kelleher, and DJ Chisolm), The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
| | - Danielle P Tyson
- Division of Epidemiology (DP Tyson), College of Public Health, The Ohio State University, Columbus, Ohio.
| | - Mattina A Davenport
- Center for Child Health Equity and Outcomes Research (LJ Chavez, MA Davenport, KJ Kelleher, and DJ Chisolm), The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
| | - Kelly J Kelleher
- Center for Child Health Equity and Outcomes Research (LJ Chavez, MA Davenport, KJ Kelleher, and DJ Chisolm), The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Division of Health Behavior and Health Promotion (KJ Kelleher), College of Public Health, The Ohio State University, Columbus, Ohio; Department of Pediatrics (KJ Kelleher and DJ Chisolm), College of Medicine, The Ohio State University, Columbus, Ohio.
| | - Deena J Chisolm
- Center for Child Health Equity and Outcomes Research (LJ Chavez, MA Davenport, KJ Kelleher, and DJ Chisolm), The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics (KJ Kelleher and DJ Chisolm), College of Medicine, The Ohio State University, Columbus, Ohio.
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Lutz MR, Garg A, Solomon BS. Addressing Social Determinants of Health in Practice. Pediatr Clin North Am 2023; 70:695-708. [PMID: 37422309 DOI: 10.1016/j.pcl.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
This review summarizes the current pediatric literature related to social determinants of health, including strengths and weaknesses of screening practices and intervention strategies, common concerns and potential unintended consequences, opportunities for further research, and provides evidence-informed practical strategies for clinicians.
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Affiliation(s)
- Melissa R Lutz
- Department of Pediatrics, Johns Hopkins University School of Medicine, 200 North Wolfe Street, Room 2088, Baltimore, MD 21287, USA
| | - Arvin Garg
- Department of Pediatrics, Child Health Equity Center, UMass Chan Medical School, UMass Memorial Children's Medical Center, 55 Lake Avenue North, Suite S5-856, Worcester, MA 01655, USA
| | - Barry S Solomon
- Department of Pediatrics, Johns Hopkins University School of Medicine, 200 North Wolfe Street, Room 2055, Baltimore, MD 21287, USA.
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Spain AK, Korfmacher J, McCrae JS. Coordination challenges and promising practices for pediatric healthcare-community partnerships: A multi-site study. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:2117-2132. [PMID: 36811161 DOI: 10.1002/jcop.23015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/16/2023] [Accepted: 02/02/2023] [Indexed: 06/14/2023]
Abstract
There have been delays integrating universal screening and referral for social needs in pediatric practice. The study investigated two frameworks for clinic-based screen-and-refer practice in eight clinics. The frameworks depict different organizational strategies to bolster family access to community resources. We conducted semi-structured interviews with healthcare and community partners at two timepoints (n = 65) to investigate start-up and ongoing implementation experiences, including continuing challenges. Results highlighted common within-clinic and clinic-community coordination challenges across diverse settings as well as promising practices supported by the two frameworks. In addition, we identified ongoing implementation challenges that face efforts to integrate these approaches and to translate screening results into activities that help children and families. Assessing the existing service referral coordination infrastructure of each clinic and community in early implementation is critical to screen-and-refer practice as this influences the continuum of supports available to meet family needs.
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Affiliation(s)
- Angeline K Spain
- Chapin Hall at the University of Chicago, Chicago, Illinois, USA
| | - Jon Korfmacher
- Chapin Hall at the University of Chicago, Chicago, Illinois, USA
| | - Julie S McCrae
- Chapin Hall at the University of Chicago, Chicago, Illinois, 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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Arbour M, Fico P, Floyd B, Morton S, Hampton P, Murphy Sims J, Atwood S, Sege R. Sustaining and scaling a clinic-based approach to address health-related social needs. FRONTIERS IN HEALTH SERVICES 2023; 3:1040992. [PMID: 36926501 PMCID: PMC10012656 DOI: 10.3389/frhs.2023.1040992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/25/2023] [Indexed: 02/19/2023]
Abstract
Objective Scaling evidence-based interventions (EBIs) from pilot phase remains a pressing challenge in efforts to address health-related social needs (HRSN) and improve population health. This study describes an innovative approach to sustaining and further spreading DULCE (Developmental Understanding and Legal Collaboration for Everyone), a universal EBI that supports pediatric clinics to implement the American Academy of Pediatrics' Bright Futures™ guidelines for infants' well-child visits (WCVs) and introduces a new quality measure of families' HRSN resource use. Methods Between August 2018 and December 2019, seven teams in four communities in three states implemented DULCE: four teams that had been implementing DULCE since 2016 and three new teams. Teams received monthly data reports and individualized continuous quality improvement (CQI) coaching for six months, followed by lighter-touch support via quarterly group calls (peer-to-peer learning and coaching). Run charts were used to study outcome (percent of infants that received all WCVs on time) and process measures (percent of families screened for HRSN and connected to resources). Results Integrating three new sites was associated with an initial regression of outcome: 41% of infants received all WCVs on time, followed by improvement to 48%. Process performance was sustained or improved: among 989 participating families, 84% (831) received 1-month WCVs on time; 96% (946) were screened for seven HRSN, 54% (508) had HRSN, and 87% (444) used HRSN resources. Conclusion An innovative, lighter-touch CQI approach to a second phase of scale-up resulted in sustainment or improvements in most processes and outcomes. Outcomes-oriented CQI measures (family receipt of resources) are an important addition to more traditional process-oriented indicators.
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Affiliation(s)
- MaryCatherine Arbour
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Placidina Fico
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Baraka Floyd
- Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | | | - Patsy Hampton
- Center for the Study of Social Policy, Washington, D.C., United States
| | - Jennifer Murphy Sims
- Early Intervention Services, UCSF Benioff Children's Hospital, Oakland, CA, United States
| | - Sidney Atwood
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Robert Sege
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States
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Arbour M, Fico P, Atwood S, Sege R. Benefits of a Universal Intervention in Pediatric Medical Homes to Identify and Address Health-Related Social Needs: An Observational Cohort Study. Acad Pediatr 2022; 22:1328-1337. [PMID: 35863734 DOI: 10.1016/j.acap.2022.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/17/2022] [Accepted: 06/23/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Compare rates of identification of families with health-related social needs (HRSN) and connection to resources by targeted versus universal, pediatric clinic-based interventions. METHODS This observational cohort study included 1677 families that received care (January 2017-May 2020) at 8 pediatric medical homes in 3 states implementing Developmental Understanding and Legal Collaboration for Everyone (DULCE)-a universal, evidence-based intervention that addresses HRSN for families with infants. We divided the cohort into 2 groups using 4 common risk criteria in targeted programs serving families with infants; 862 families had no high-risk characteristics (Risk Criteria Absent [RCA]); 815 families had high-risk characteristics (Risk Criteria Present [RCP]). We compared both groups by prevalence of HRSN and connection to supports and estimated the performance of high-risk criteria to identify HRSN. RESULTS DULCE identified 990 families with HRSN, compared to an estimated 274 families, if a risk-targeted approach had been used. More than half of RCA families had HRSN, 11% used resources at enrollment, and 42.5% accessed resources through DULCE. Simultaneously, 68.8% of RCP families had ongoing HRSN although 46.0% used resources at enrollment; 63.9% accessed additional resources through DULCE. Commonly used risk criteria had a sensitivity of 55.3% (95% confidence interval [CI], 52.2%-58.5%), specificity of 61.1% (95% CI, 57.2%-64.9%), positive predictive value of 68.8% (95% CI, 65.4%-72.0%), and negative predictive value of 46.9% (95% CI, 43.5%-50.4%). CONCLUSIONS Risk criteria commonly used to identify families for targeted interventions are imperfect proxies for HRSN. Universal, medical home-based approaches can play a key role in supporting families with infants.
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Affiliation(s)
- MaryCatherine Arbour
- Division of Global Health Equity, Brigham and Women's Hospital (M Arbour, P Fico, and A Atwood), Boston, Mass.
| | - Placidina Fico
- Division of Global Health Equity, Brigham and Women's Hospital (M Arbour, P Fico, and A Atwood), Boston, Mass
| | - Sidney Atwood
- Division of Global Health Equity, Brigham and Women's Hospital (M Arbour, P Fico, and A Atwood), Boston, Mass
| | - Robert Sege
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center (R Sege), Boston, Mass
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11
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Rosenberg J, Rosenthal A, Castillo S, Edwards E, Erickson C, Nogelo P, Fenick AM. Medical Certification for Utility Shut-Off Protection and Health-Related Social Needs. Pediatrics 2022; 150:e2022057571. [PMID: 36226533 PMCID: PMC9647589 DOI: 10.1542/peds.2022-057571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children in families facing energy insecurity have greater odds of poor health and developmental problems. In this study of families who requested and received medical certification for utility shut-off protection and were contacted by our Medical Legal Partnership (MLP), we aimed to assess concurrent health-related social needs related to utilities, housing, finances, and nutrition. METHODS After medical certificates were completed at our academic pediatric center, our MLP office contacted families and assessed utility concerns as well as other health, social, and legal needs. In this observational study, we present descriptive analyses of patients who received certificates from September 2019 to May 2020 via data collected through the MLP survey during the coronavirus disease 2019 pandemic (June 2020-December 2021). RESULTS Of 167 families who received utility shut-off protection from September 2019 to May 2020, 84 (50.3%) parents and guardians were successfully contacted. Most (93%) found the medical certificate helpful. Additionally, 68% had applied for Energy Assistance, and 69% reported they were on utility company payment plans. Most (78%) owed arrearages, ranging from under $500 to over $20 000, for gas, electric, and/or water bills. Food, housing, and financial insecurity screening positivity rates were 65%, 85%, and 74%, respectively. CONCLUSIONS Patients who were contacted by an MLP after receiving medical certification for utility shutoff protection were found to have challenges paying for utilities and faced multiple food, housing, and financial stressors. Through consultation and completion of medical forms for utility shutoff protection, pediatricians and MLPs can provide resources and advocacy to support families' physical, emotional, and psychosocial needs.
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Affiliation(s)
| | - Alice Rosenthal
- Yale School of Medicine, New Haven, Connecticut
- Yale New Haven Hospital, New Haven, Connecticut
- Center for Children’s Advocacy, Hartford, Connecticut
| | | | - Emily Edwards
- Frank H. Netter School of Medicine, Quinnipiac University, Hamden, Connecticut
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Hill S, Topel K, Li X, Solomon BS. Engagement in a Social Needs Navigation Program and Health Care Utilization in Pediatric Primary Care. Acad Pediatr 2022; 22:1221-1227. [PMID: 35597440 DOI: 10.1016/j.acap.2022.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/02/2022] [Accepted: 05/12/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Evidence for social needs interventions on resource linkage has grown over the past decade. Though social and economic needs predict health care 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 2 primary care clinics. METHODS A retrospective cohort study was conducted of patients in 2 clinics referred to a social risk screening and navigation program between June and August 2018. We compared health care 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. RESULTS During the study period, of the 969 patients referred to the program, 761 were enrolled across the 2 clinics. At both sites, the majority of enrolled patients had high WCV attendance postintervention (Site A: 81.6%, Site B: 71.4%). High WCV attendance for nonenrolled 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 nonenrolled patients, adjusting for preintervention utilization (Site A adjusted odds ratio [aOR]: 5.83, Site B aOR : 4.20). There were no significant differences in ED use at either clinic. CONCLUSIONS Addressing families' social needs through resource linkage and navigation can improve WCV attendance.
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Affiliation(s)
- Sarah Hill
- Johns Hopkins University School of Medicine (S Hill, K Topel, and BS Solomon), Baltimore, Md
| | - Kristin Topel
- Johns Hopkins University School of Medicine (S Hill, K Topel, and BS Solomon), Baltimore, Md
| | - Ximin Li
- Johns Hopkins Berman Institute of Bioethics (X Li), Baltimore, Md
| | - Barry S Solomon
- Johns Hopkins University School of Medicine (S Hill, K Topel, and BS Solomon), Baltimore, Md.
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Tyson DP, Kelleher KJ, Chavez LJ. Mental Health-related Utilization of Emergency Departments During Pregnancy in the U.S., 2016-2019. Matern Child Health J 2022; 26:1953-1958. [PMID: 35994129 DOI: 10.1007/s10995-022-03487-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/24/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Mental health conditions are a leading comorbidity of pregnancy, but little is known about the use of emergency departments (EDs) for mental health-related care during pregnancy. This study aims to describe both the characteristics of pregnant women who receive mental health-related care in hospital EDs in the United States and the most common mental health diagnoses, types of medications, and mental health services that these women receive. METHODS Pooled, cross-sectional data from the National Hospital Ambulatory Medical Care Survey (2016-2019) were used. Pregnant patients were identified based on diagnosis and reason for visit codes. Weighted descriptive analyses were performed to describe characteristics of pregnant women, services offered, and medications received for mental health-related visits. RESULTS Mental health-related visits comprised 6.2% of all ED visits during pregnancy. History of depression was significantly higher in pregnant patients with mental health-related visits compared to those pregnant patients presenting for other reasons. The most common diagnoses for pregnant patients with mental health-related visits were substance use disorders (30.7%), anxiety-related disorders (19.1%), and depressive disorders (14.6%). Anxiolytics and antidepressants were the most common pharmacotherapies given. Few women saw a mental health provider during their visit (6.7%), while most were referred to an outside clinic for follow-up (55.0%). DISCUSSION Many pregnant women seek care from EDs for mental health-related reasons. It remains important to train health care professionals who treat pregnant women in EDs how to deliver effective treatments, particularly for substance use disorders and anxiety. SIGNIFICANCE Many pregnant patients receive care in emergency departments during pregnancy. Despite mental health conditions being a leading comorbidity of pregnancy, little is known about the use of emergency departments for mental health-related reasons during pregnancy. This study is the first to analyze a representative sample of emergency department visits by pregnant women in the United States between 2016 and 2019 and report on mental health-related visits. Among pregnant women seen in the ED for mental health-related reasons, the most common diagnoses were substance use disorders, anxiety-related disorders, and depressive disorders, but few saw a mental health provider during their visit.
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Affiliation(s)
- Danielle P Tyson
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, 43205, Columbus, OH, USA.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Kelly J Kelleher
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, 43205, Columbus, OH, USA.,Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Laura J Chavez
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, 43205, Columbus, OH, USA.
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Anyigbo C, Jimenez ME, Sosnowski DW. Association Between Adverse Childhood Experiences at Age 5 Years and Healthcare Utilization at Age 9 Years. J Pediatr 2022; 246:227-234.e2. [PMID: 35427692 DOI: 10.1016/j.jpeds.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/01/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine associations between adverse childhood experiences (ACEs) at age 5 years and healthcare utilization patterns at age 9 years. STUDY DESIGN We conducted a secondary analysis using longitudinal data from the Fragile Families and Child Wellbeing Study. Caregivers (n = 2521) provided data on their child's ACEs at age 5 years and on 4 types of healthcare utilization at age 9 years: past-year well visits, dental visits, primary care sick visits for injury or illness, and emergency room (ER) visits. Logistic regression analysis was used to examine the association between ACEs at age 5 and each type of healthcare utilization, adjusting for relevant sociodemographic covariates. RESULTS Among the 2521 children (51% male, 48% Non-Hispanic Black), 77% had ≥1 ACE at age 5. Children with ≥4 ACEs had lower odds of a dental visit (aOR, 0.51; 95% CI, 0.29-0.91) and higher odds of a primary care sick visit (aOR, 1.77; 95% CI, 1.20-2.64) and an ER visit (aOR, 1.70; 95% CI, 1.11-2.59) compared with children with no reported ACEs. CONCLUSION Our findings demonstrate suboptimal healthcare utilization patterns among families with ACEs and indicate a need for targeted interventions that support appropriate healthcare utilization for children who endure adversity.
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Affiliation(s)
- Chidiogo Anyigbo
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH.
| | - Manuel E Jimenez
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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15
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Anderst A, Hunter K, Andersen M, Walker N, Coombes J, Raman S, Moore M, Ryan L, Jersky M, Mackenzie A, Stephensen J, Williams C, Timbery L, Doyle K, Lingam R, Zwi K, Sheppard-Law S, Erskine C, Clapham K, Woolfenden S. Screening and social prescribing in healthcare and social services to address housing issues among children and families: a systematic review. BMJ Open 2022; 12:e054338. [PMID: 35487725 PMCID: PMC9058796 DOI: 10.1136/bmjopen-2021-054338] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Housing is a social determinant of health that impacts the health and well-being of children and families. Screening and referral to address social determinants of health in clinical and social service settings has been proposed to support families with housing problems. This study aims to identify housing screening questions asked of families in healthcare and social services, determine validated screening tools and extract information about recommendations for action after screening for housing issues. METHODS The electronic databases MEDLINE, PsycINFO, EMBASE, Ovid Emcare, Scopus and CINAHL were searched from 2009 to 2021. Inclusion criteria were peer-reviewed literature that included questions about housing being asked of children or young people aged 0-18 years and their families accessing any healthcare or social service. We extracted data on the housing questions asked, source of housing questions, validity and descriptions of actions to address housing issues. RESULTS Forty-nine peer-reviewed papers met the inclusion criteria. The housing questions in social screening tools vary widely. There are no standard housing-related questions that clinical and social service providers ask families. Fourteen screening tools were validated. An action was embedded as part of social screening activities in 27 of 42 studies. Actions for identified housing problems included provision of a community-based or clinic-based resource guide, and social prescribing included referral to a social worker, care coordinator or care navigation service, community health worker, social service agency, referral to a housing and child welfare demonstration project or provided intensive case management and wraparound services. CONCLUSION This review provides a catalogue of housing questions that can be asked of families in the clinical and/or social service setting, and potential subsequent actions.
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Affiliation(s)
- Ania Anderst
- Aboriginal and Torres Strait Islander Health Program, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Kate Hunter
- Aboriginal and Torres Strait Islander Health Program, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Melanie Andersen
- Aboriginal and Torres Strait Islander Health Program, The George Institute for Global Health, Newtown, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Natasha Walker
- Aboriginal and Torres Strait Islander Health Program, The George Institute for Global Health, Newtown, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Julieann Coombes
- Aboriginal and Torres Strait Islander Health Program, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Shanti Raman
- Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Melinda Moore
- Sydney Children's Hospitals Network (Randwick Campus), Sydney, New South Wales, Australia
| | - Lola Ryan
- Child, Youth and Family Services, Population and Community Health, South Eastern Sydney Local Health District, Kogarah, New South Wales, Australia
| | - Michelle Jersky
- Sydney Children's Hospitals Network (Randwick Campus), Sydney, New South Wales, Australia
| | - Amy Mackenzie
- Sydney Children's Hospitals Network (Randwick Campus), Sydney, New South Wales, Australia
| | - Jennifer Stephensen
- Sydney Children's Hospitals Network (Randwick Campus), Sydney, New South Wales, Australia
| | - Carina Williams
- Youth Health Services, Community Health, NSW Health, Sydney, New South Wales, Australia
| | - Lee Timbery
- Sydney Children's Hospitals Network (Randwick Campus), Sydney, New South Wales, Australia
| | - Kerrie Doyle
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Raghu Lingam
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Karen Zwi
- Sydney Children's Hospitals Network (Randwick Campus), Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Suzanne Sheppard-Law
- Faculty of Health, School of Nursing and Midwifery, University of Technology Sydney, Broadway, New South Wales, Australia
| | | | - Kathleen Clapham
- Ngarruwan Ngadju First Peoples Health and Wellbeing Research Centre, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Susan Woolfenden
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Community Paediatrics Research Group, Institute for Women, Children and Families, Sydney Local Health District, Sydney, New South Wales, Australia
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