Increase in Social Determinants of Health-related Needs During the COVID-19 Pandemic

Background: Social determinants of health (SDoH) influence the health and psychosocial well-being of children and families. Several national organizations, including the AAP, recommend that primary care practices implement an approach to screening for SDoH at all health supervision visits to identify and address risks. The COVID-19 pandemic has placed additional stress on patients, families, and their communities and has highlighted the challenges we continue to face in efforts to achieve health equity. In our primary care pediatric clinic, we have analyzed our existing SDoH screening and referral process and have found an exponential increase in resource needs for our patients and families in the setting of the COVID-19 pandemic.

Methods: We administered SDoH screening forms based on a modified PQ-R to families at every well child visit from 2019-2021 in our pediatric primary care clinic and resident continuity practice. We partnered with the Health Equity Project at Albany Medical College which is a service-learning program that provides public health outreach to families who have screened positive for 1 or more SDoH need. Starting in February 2021, families have been contacted at 1-and 3-month intervals following initial referral to determine if resources were accessed. This follow up has allowed for identification of barriers to connecting with community-based organizations. We analyzed positive screens pre-COVID and during the COVID pandemic to assess the impact of COVID on our patient population.

Results: Since August 2019, 507 families in total have screened positive for one or more need based on SDoH screening in our clinic. Out of the 507 families, 70% have been contacted successfully by our public health outreach team to provide resource referrals. During our pre-COVID screening period from August 2019-February 2020 there were 77 positive screens compared to the COVID screening period August 2020-February 2021 during which were 231 positive screens. This represents a 200% increase in positive screens during this time. We have identified several barriers to connecting with community resources as reported by families, such as difficulty finding time to contact the given resources and experiencing long wait times to receive assistance.

Conclusion: SDoH screening in primary care has been widely recognized as a method to identify and address targeted risk factors to improve the health and well-being of children. We have identified an increasing need for resources in our patient population since the start of the COVID-19 pandemic. Future study is needed to identify barriers between referral and provision of resources by community-based organizations and to address the impact of our referral process on health outcomes. Our findings do underscore the impact that the COVID-19 pandemic has had on the social wellbeing of children in our community, and this must be considered in the delivery of their health care.