Laura M Gottlieb1, Danielle Hessler2, Dayna Long3, Ellen Laves4, Abigail R Burns5, Anais Amaya2, Patricia Sweeney6, Christine Schudel7, Nancy E Adler8. 1. Department of Family and Community Medicine, University of California, San Francisco2Center for Health and Community, University of California, San Francisco. 2. Department of Family and Community Medicine, University of California, San Francisco. 3. Primary Care Clinic, Benioff Children's Hospital, University of California, Oakland4currently with the Center for Community Health and Engagement, Benioff Children's Hospital, University of California, Oakland. 4. Department of Pediatrics, University of California, San Francisco. 5. School of Medicine, University of California, San Francisco. 6. student, School of Nursing, University of California, San Francisco. 7. Primary Care Clinic, Benioff Children's Hospital, University of California, Oakland. 8. Center for Health and Community, University of California, San Francisco.
Abstract
Importance: Social determinants of health shape both children's immediate health and their lifetime risk for disease. Increasingly, pediatric health care organizations are intervening to address family social adversity. However, little evidence is available on the effectiveness of related interventions. Objective: To evaluate the effects of social needs screening and in-person resource navigation services on social needs and child health. Design, Setting, and Participants: Patients were randomized to intervention or active control conditions by the day of the week. Primary outcomes observed at 4 months after enrollment included caregivers' reports of social needs and child health status. Recruitment occurred between October 13, 2013, and August 27, 2015, in pediatric primary and urgent care clinics in 2 safety-net hospitals. Participants were English-speaking or Spanish-speaking caregivers accompanying minor children to nonacute medical visits. Interventions: After standardized screening, caregivers either received written information on relevant community services (active control) or received in-person help to access services with follow-up telephone calls for further assistance if needed (navigation intervention). Main Outcomes and Measures: Change in reported social needs and in caregiver assessment of child's overall health reported 4 months later. Results: Among 1809 patients enrolled in the study, evenly split between the 2 sites, 31.6% (n = 572) were enrolled in a primary care clinic and 68.4% (n = 1237) were enrolled in an urgent care setting. The children were primarily Hispanic white individuals (50.9% [n = 921]) and non-Hispanic black individuals (26.2% [n = 473]) and had a mean (SD) age of 5.1 (4.8) years; 50.5% (n = 913) were female. The reported number of social needs at baseline ranged from 0 to 11 of 14 total possible items, with a mean (SD) of 2.7 (2.2). At 4 months after enrollment, the number of social needs reported by the intervention arm decreased more than that reported by the control arm, with a mean (SE) change of -0.39 (0.13) vs 0.22 (0.13) (P < .001). In addition, caregivers in the intervention arm reported significantly greater improvement in their child's health, with a mean (SE) change of -0.36 (0.05) vs -0.12 (0.05) (P < .001). Conclusions and Relevance: To our knowledge, this investigation is the first randomized clinical trial to evaluate health outcomes of a pediatric social needs navigation program. Compared with an active control at 4 months after enrollment, the intervention significantly decreased families' reports of social needs and significantly improved children's overall health status as reported by caregivers. These findings support the feasibility and potential effect of addressing social needs in pediatric health care settings. Trial Registration: clinicaltrials.gov Identifier: NCT01939704.
RCT Entities:
Importance: Social determinants of health shape both children's immediate health and their lifetime risk for disease. Increasingly, pediatric health care organizations are intervening to address family social adversity. However, little evidence is available on the effectiveness of related interventions. Objective: To evaluate the effects of social needs screening and in-person resource navigation services on social needs and child health. Design, Setting, and Participants: Patients were randomized to intervention or active control conditions by the day of the week. Primary outcomes observed at 4 months after enrollment included caregivers' reports of social needs and child health status. Recruitment occurred between October 13, 2013, and August 27, 2015, in pediatric primary and urgent care clinics in 2 safety-net hospitals. Participants were English-speaking or Spanish-speaking caregivers accompanying minor children to nonacute medical visits. Interventions: After standardized screening, caregivers either received written information on relevant community services (active control) or received in-person help to access services with follow-up telephone calls for further assistance if needed (navigation intervention). Main Outcomes and Measures: Change in reported social needs and in caregiver assessment of child's overall health reported 4 months later. Results: Among 1809 patients enrolled in the study, evenly split between the 2 sites, 31.6% (n = 572) were enrolled in a primary care clinic and 68.4% (n = 1237) were enrolled in an urgent care setting. The children were primarily Hispanic white individuals (50.9% [n = 921]) and non-Hispanic black individuals (26.2% [n = 473]) and had a mean (SD) age of 5.1 (4.8) years; 50.5% (n = 913) were female. The reported number of social needs at baseline ranged from 0 to 11 of 14 total possible items, with a mean (SD) of 2.7 (2.2). At 4 months after enrollment, the number of social needs reported by the intervention arm decreased more than that reported by the control arm, with a mean (SE) change of -0.39 (0.13) vs 0.22 (0.13) (P < .001). In addition, caregivers in the intervention arm reported significantly greater improvement in their child's health, with a mean (SE) change of -0.36 (0.05) vs -0.12 (0.05) (P < .001). Conclusions and Relevance: To our knowledge, this investigation is the first randomized clinical trial to evaluate health outcomes of a pediatric social needs navigation program. Compared with an active control at 4 months after enrollment, the intervention significantly decreased families' reports of social needs and significantly improved children's overall health status as reported by caregivers. These findings support the feasibility and potential effect of addressing social needs in pediatric health care settings. Trial Registration: clinicaltrials.gov Identifier: NCT01939704.
Authors: Kimberly C Arthur; Barbara A Lucenko; Irina V Sharkova; Jingping Xing; Rita Mangione-Smith Journal: Ann Fam Med Date: 2018-01 Impact factor: 5.166
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Authors: Andrew F Beck; Alicia J Cohen; Jeffrey D Colvin; Caroline M Fichtenberg; Eric W Fleegler; Arvin Garg; Laura M Gottlieb; Matthew S Pantell; Megan T Sandel; Adam Schickedanz; Robert S Kahn Journal: Pediatr Res Date: 2018-05-23 Impact factor: 3.756