At the Source: Family Preferences on Reporting Social Needs in the Pediatric Emergency Department

Background: Social determinants of health (SDOH) research has become increasingly prominent in clinical pediatrics. Research has demonstrated high rates of social need in the emergency department (ED), which physicians report feeling unprepared to manage. Prior studies, largely based on convenience sampling, address family disclosure rates of social need rather than family preferences around ED-based screening practices. We thus sought to understand family preferences on screening modality (tablet, cell phone or paper) and timing (beginning or end of visit) when in the ED.

Methods: Families are assigned to 1 of 6 arms of modality and timing at random based on their child’s ED room number and alerted by nurses to complete a one-time anonymous, self-administered, short survey in Spanish or English (Figure 1). Prior research was done to assess the validity and reliability of the survey, which includes six areas of social need: health care access, housing and utilities, nutrition and child activities, family services and transportation, education and employment, and legal needs. Free community resource information is available to all families regardless of participation. We assessed family opinion on 1) ease of survey completion, 2) preferred modality of use (tablet, cell phone or paper), 3) preferred timing of survey (beginning or end of ED visit), and 4) preferred modality of community resource information (email, text message or paper); we then calculated frequency distributions for each of the specified metrics.

Results: A total of 234 surveys have been completed since the study began in March 2021: 24 tablet (10%), 89 cell phone (38%) and 121 paper (52%) by English- (N = 173) and Spanish-speaking (N = 61) families. Social need in healthcare (25%), housing and utilities (22%), and nutrition and child activities (18%) together composed the majority. The distribution of reported need was similar among the 3 modalities. The majority of families reported a preference to the modality they had used: paper 79%, cell phone 84%, tablet 63%. Nearly all families (95%) reported survey completion was ‘very easy’ or ‘easy’ regardless of modality used. The amount of social need disclosure for families reporting 3-4 needs was 21% among the tablet group, 13% in paper, and 11% in cell phone groups. There was a slight preference to completing surveys at the end of the ED visit (55%). Families reported a preference for electronic-based (text message or email) community resource information (70%) compared to paper.

Conclusion: In this ongoing study, we demonstrate a model for logistic integration of social needs assessments into ED nursing flow with ease of completion by families. Randomization in our study methods lends a strength to the literature in designing and evaluating ED-based screening process.