P0043 - Development of a Screening Tool for Social Determinants of Health at a Federally Qualified Health Center
Background: Adverse social conditions in childhood contribute to an increased burden of acute and chronic disease in adult life. Childhood exposure to poverty, financial stress, food insecurity, housing instability, and poor housing quality is associated with stress, academic and cognitive deficits, socio-emotional difficulties, and poor health status. Screening for social determinants of health (SDH) in pediatric practices increases referrals to community-based resources, decreases social needs, and improves parent-reported child health. The American Academy of Pediatrics (AAP) therefore recommends screening for SDH at every health supervision visit from birth until age 21. However, there is no consensus regarding the best SDH screening tool. The lack of consensus exists because SDH are context dependent, family needs vary between communities, and screening program effectiveness is impacted by what resources are available to act on positive screens. These barriers to standardization leave room for personalization of screening by pediatric providers.
Methodology: The Eric B. Chandler Health Center (EBCHC) is a federally qualified health center in New Brunswick, New Jersey. To assess the social needs of pediatric patients at EBCHC, a SDH screening tool was developed. The tool was designed as paper handout with a series of “yes-no” questions, assessing families’ interest in resources related to eight SDH (see figure 1). A series of plan-do-study-act (PDSA) cycles were then begun to optimize the tool for the EBCHC pediatric patient population. The tool was administered to families at well-child visits and feedback was elicited from families, physicians, social workers, and community health workers. The tool was then revised and another cycle begun. Throughout implementation, positive screens (≥1 “yes” response) were referred to the EBCHC community health worker, who provided resources and/or counseling.
Discussion: Overall, information on school training and health insurance were the most desired resources. Reflective of this trend, school training and health insurance were the most commonly desired resources among Spanish-speaking patients. Among English-speaking patients, however, diapers and children’s clothing were most commonly desired. After repeated PDSA cycles, a transition to an electronic medical record (EMR)-based tool was proposed to enable ICD-10 coding of responses. To facilitate the paper-to-EMR transition, the tool was changed to a modified version of the Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE) screening tool (see figure 2). A trial of this tool is currently underway.
Conclusion: The PDSA cycles performed during this project exemplify the importance of interdisciplinary input in designing SDH screening tools. Feedback from families and allied healthcare providers allowed optimization of the SDH screening for the target population and interdisciplinary collaboration enabled linkage between screening and referral for services. As the EMR-based tool is implemented, it will facilitate collection of longitudinal data that will be used to further improve screening.