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Original Investigation |

Effects of Social Needs Screening and In-Person Service Navigation on Child Health A Randomized Clinical Trial ONLINE FIRST

Laura M. Gottlieb, MD, MPH1,2; Danielle Hessler, PhD1; Dayna Long, MD3,4; Ellen Laves, MD5; Abigail R. Burns, MDc, MSWc6; Anais Amaya, BA1; Patricia Sweeney, BA7; Christine Schudel, MSW, MPH3; Nancy E. Adler, PhD2
[+] Author Affiliations
1Department of Family and Community Medicine, University of California, San Francisco
2Center for Health and Community, University of California, San Francisco
3Primary Care Clinic, Benioff Children’s Hospital, University of California, Oakland
4currently with the Center for Community Health and Engagement, Benioff Children’s Hospital, University of California, Oakland
5Department of Pediatrics, University of California, San Francisco
6School of Medicine, University of California, San Francisco
7student, School of Nursing, University of California, San Francisco
JAMA Pediatr. Published online September 06, 2016. doi:10.1001/jamapediatrics.2016.2521
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Importance  Social determinants of health shape both children’s immediate health and their lifetime risk for disease. Increasingly, pediatric health care organizations are intervening to address family social adversity. However, little evidence is available on the effectiveness of related interventions.

Objective  To evaluate the effects of social needs screening and in-person resource navigation services on social needs and child health.

Design, Setting, and Participants  Patients were randomized to intervention or active control conditions by the day of the week. Primary outcomes observed at 4 months after enrollment included caregivers’ reports of social needs and child health status. Recruitment occurred between October 13, 2013, and August 27, 2015, in pediatric primary and urgent care clinics in 2 safety-net hospitals. Participants were English-speaking or Spanish-speaking caregivers accompanying minor children to nonacute medical visits.

Interventions  After standardized screening, caregivers either received written information on relevant community services (active control) or received in-person help to access services with follow-up telephone calls for further assistance if needed (navigation intervention).

Main Outcomes and Measures  Change in reported social needs and in caregiver assessment of child’s overall health reported 4 months later.

Results  Among 1809 patients enrolled in the study, evenly split between the 2 sites, 31.6% (n = 572) were enrolled in a primary care clinic and 68.4% (n = 1237) were enrolled in an urgent care setting. The children were primarily Hispanic white individuals (50.9% [n = 921]) and non-Hispanic black individuals (26.2% [n = 473]) and had a mean (SD) age of 5.1 (4.8) years; 50.5% (n = 913) were female. The reported number of social needs at baseline ranged from 0 to 11 of 14 total possible items, with a mean (SD) of 2.7 (2.2). At 4 months after enrollment, the number of social needs reported by the intervention arm decreased more than that reported by the control arm, with a mean (SE) change of −0.39 (0.13) vs 0.22 (0.13) (P < .001). In addition, caregivers in the intervention arm reported significantly greater improvement in their child’s health, with a mean (SE) change of −0.36 (0.05) vs −0.12 (0.05) (P < .001).

Conclusions and Relevance  To our knowledge, this investigation is the first randomized clinical trial to evaluate health outcomes of a pediatric social needs navigation program. Compared with an active control at 4 months after enrollment, the intervention significantly decreased families’ reports of social needs and significantly improved children’s overall health status as reported by caregivers. These findings support the feasibility and potential effect of addressing social needs in pediatric health care settings.

Trial Registration  clinicaltrials.gov Identifier: NCT01939704

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