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Acad Pediatr. 2016 Mar;16(2):168-74. doi: 10.1016/j.acap.2015.06.001. Epub 2015 Jul 14.

Multiple Behavior Change Intervention to Improve Detection of Unmet Social Needs and Resulting Resource Referrals.

Author information

1
Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Mo; Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Mo. Electronic address: jdcolvin@cmh.edu.
2
Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Mo; Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Mo.
3
Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Calif.
4
Work Group for Community Health and Development, University of Kansas, Lawrence, Kans.
5
Department of Social Work, Children's Mercy Hospitals and Clinics, Kansas City, Mo.
6
Turner House Children's Clinic, Kansas City, Kans.
7
Departments of Pediatrics and Health Policy & Management, University of California, Los Angeles, Calif; Children's Discovery and Innovation Institute, Mattel Children's Hospital UCLA, Los Angeles, Calif; RAND Health, The RAND Corporation, Santa Monica, Calif.

Abstract

OBJECTIVE:

It is critical that pediatric residents learn to effectively screen families for active and addressable social needs (ie, negative social determinants of health). We sought to determine 1) whether a brief intervention teaching residents about IHELP, a social needs screening tool, could improve resident screening, and 2) how accurately IHELP could detect needs in the inpatient setting.

METHODS:

During an 18-month period, interns rotating on 1 of 2 otherwise identical inpatient general pediatrics teams were trained in IHELP. Interns on the other team served as the comparison group. Every admission history and physical examination (H&P) was reviewed for IHELP screening. Social work evaluations were used to establish the sensitivity and specificity of IHELP and document resources provided to families with active needs. During a 21-month postintervention period, every third H&P was reviewed to determine median duration of continued IHELP use.

RESULTS:

A total of 619 admissions met inclusion criteria. Over 80% of intervention team H&Ps documented use of IHELP. The percentage of social work consults was nearly 3 times greater on the intervention team than on the comparison team (P < .001). Among H&Ps with documented use of IHELP, specificity was 0.96 (95% confidence interval 0.87-0.99) and sensitivity was 0.63 (95% confidence interval 0.50-0.73). Social work provided resources for 78% of positively screened families. The median duration of screening use by residents after the intervention was 8.1 months (interquartile range 1-10 months).

CONCLUSIONS:

A brief intervention increased resident screening and detection of social needs, leading to important referrals to address those needs.

KEYWORDS:

health status disparities; poverty; social determinants of health; socioeconomic factors; vulnerable populations

PMID:
26183003
PMCID:
PMC4712125
[Available on 2017-03-01]
DOI:
10.1016/j.acap.2015.06.001
[Indexed for MEDLINE]
Free PMC Article

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