O2056: Social Needs Screening During Pediatric Emergency Department Visits: Language Differences in Reported Needs

Background: A pediatric emergency department (PED) serves as part of the social safety net for families who lack consistent care access, have limited English proficiency (LEP), and may have other social vulnerabilities. PED visits are opportunities to perform social needs screening and link families with unmet social needs (USN) to community resources. Language differences in reported social needs screening during PED visits are insufficiently described to guide inclusive, equitable practices.

Methods: We conducted a cross-sectional, descriptive study at a free-standing children’s hospital PED. Research assistants approached a convenience sample of English- and Spanish-speaking caregivers of patients < 18 years of age. Each enrolled caregiver was offered a pediatric version of the validated Screener for Intensifying Community Referrals for Health (p-SINCERE) and given United Way 211 resource cards. In the caregiver’s self-selected language, the survey assessed demographics and 10 areas of social needs. The primary outcome was prevalence of USN and examination of disparities in USN by self-selected language and patient demographics. We summarized and compared variables between self-selected language using Chi-square tests.

Results: Of the 10156 patients who presented to the PED during the study hours of 6am to midnight from 4/1/2021 to 8/3/2021, there were 9922 (97.7%) eligible, 5357 (52.7%) approached, and 3987 (39.3%) enrolled caregivers (see Figure 1). Of the 3987 caregivers enrolled, self-selected language was English for 3662 (91.8%) and Spanish for 325 (8.2%). Enrolled patients were mostly male (52%), non-Hispanic (71%), White/Caucasian (68%), had private health insurance (55%), had an English-speaking caregiver (92%), and had no USN (55%). There were 1680 (42%) enrolled caregivers with  1 USN, representing 39.7% of English-speaking caregivers and 70.2% of Spanish-speaking caregivers (p < 0.001). Patient characteristics are stratified in Table 1 by language selection. Table 2 demonstrates the significant differences (p < 0.001) across all 10 items of USN with a higher frequency of Spanish-speaking caregivers reporting “Yes” and “Decline to Answer” compared to English-speaking caregivers.

Conclusion: Screening for social needs in an urban pediatric emergency department revealed significant levels of unmet social needs (USN) and disparities related to caregiver’s language, racial/ethnic identity of child, and insurance status of child. We found that differences also existed in how English- and Spanish-speaking caregivers responded to our social need inquiries. These findings highlight the importance for social needs screening during PED visits warrant further investigation to understand why Spanish-speaking caregivers more frequently declined to answer when screened for social needs.