Elsevier

Journal of Pediatric Health Care

Volume 35, Issue 5, September–October 2021, Pages 471-478
Journal of Pediatric Health Care

Article
When Families Do Not Request Help: Assessing a Social Determinants of Health Screening Tool in Practice

https://doi.org/10.1016/j.pedhc.2021.05.002Get rights and content

Introduction

Using pediatric social determinants of health screening data from a large medical system, we explored social needs dislosures and identified which needs were associated with resource connection requests.

Method

Data came from records of outpatient pediatric patients (0–18 years) seen between October 2018 and March 2020 (39,251 encounters). We assessed percent of encounters where families (1) indicated a social need, and (2) requested a resource connection. We conducted multivariable logistic regression to identify which needs were associated with resource connection requests.

Results

Among all encounters, 8% indicated a need and 2% requested a resource connection. Among families indicating a need, needs associated with resource requests included: housing (odds ratio [OR], 3.49 [2.42–5.03]), employment (OR, 3.15 [2.21–4.50]), food (OR, 1.89 [1.41–2.52]), and transportation (OR, 1.82 [1.30–2.56]).

Discussion

Families seldom requested resource connections to address social needs. Better understanding families’ interests in receiving assistance is an important next step in pediatric social determinants of health screening system development.

Section snippets

INTRODUCTION

In the United States, over 17% of families with children live in poverty (United States Census Bureau, 2017), 14% experience food insecurity (Coleman-Jensen, Rabbitt, Gregory, & Singh, 2019), and 40% have experienced challenges in paying utility bills (U.S. Energy and Information Administration, 2015). These and other needs, a subset of social determinants of health (SDH), impede the optimal health and development of children (Goldfeld et al., 2018; Patton, Liu, Adelson, & Lucenko, 2019;

Participants

Data for the present analyses come from the medical records of pediatric patients (aged 0–18 years) within a large medical system in the Midwestern United States who were seen at an ambulatory care center between October 2018 and March 2020 and completed/had a parent or guardian (hereafter, “parent”) complete the SDH screener for the medical visit (n = 39,251 encounters; 30,486 unique children). The medical system includes nine pediatric ambulatory care sites within the Midwestern state in

RESULTS

The number of encounters peaked during the first year of life and decreased after that (solid line, Figure 1). Among all encounters in which the SDH screener was completed (n = 39,251), 8% indicated a social need. This percentage was relatively stable across ages 0–18 years, with a minimum of 6% at age 2 years and a maximum of 10% at age 18 years (light gray bars, Figure 1). Among all encounters in which an SDH screener was completed, only 2% requested a referral for their identified needs.

DISCUSSION

This paper is novel in its investigation of how frequently families report SDH versus request help addressing SDH in pediatric settings. Parents and youth requested a connection to resources only 14% of the time when they indicated a need. This elicits the question: why do families forego assistance after indicating a social need? De Marchis and colleagues have investigated this question as it relates to adult patients (De Marchis et al., 2020a; De Marchis et al., 2020b), and they posit two

Rebeccah L. Sokol, Assistant Professor, School of Social Work, Wayne State University, Detroit, MI.

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  • Cited by (0)

    Rebeccah L. Sokol, Assistant Professor, School of Social Work, Wayne State University, Detroit, MI.

    Roshanak Mehdipanah, Assistant Professor, Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI.

    Kiana Bess, Doctoral Student, Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI.

    Layla Mohammed, Clinical Assistant Professor, Ypsilanti Health Center, University of Michigan, Ypsilanti, MI.

    Alison L. Miller, Associate Professor, Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI.

    The present work was supported by a grant provided by the Childhood Obesity Research Core at the University of Michigan. The funding source had no role in the study design, data collection, analysis or interpretation of the data; in the writing of the report; and in the decision to submit the article for publication.

    The Institutional Review Board at the University of Michigan approved the present study procedures.

    Conflicts of interest: None to report.

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