Research In Practice Blog
Introduction
While social risk screening has become more prevalent in healthcare, studies show that desire for available resources doesn't always match positive screening outcomes. It's important to recognize that some individuals might hesitate to seek help due to fears of negative consequences, highlighting the need for supportive outreach and education. "The Socially Equitable Care by Understanding Resource Engagement (SECURE)" study, conducted by researchers from Clinical Futures and PolicyLab at Children’s Hospital of Philadelphia, examined how social risk screening impacts both the desire for and engagement with social resources. The findings from this study were recently published in the journal Pediatrics.
What is known about Social Risk Screening in health care:
Health care is increasingly implementing social risk screening, which can help families navigate food and housing insecurity, financial strain, and unsafe environments. However, this screening may result in inequitable identification of social needs and decreased engagement with resources due to fears of negative consequences and a mismatch between screening outcomes and the desire for resources.
How this study was performed:
In this large pragmatic, non-blinded randomized controlled trial, which spanned from April 19, 2022, to August 24, 2023, researchers enrolled a diverse multilingual sample of 3,949 caregiver- patient dyads in the emergency department and two primary care clinics associated with a children's hospital.
Participants were randomly assigned to one of three distinct intervention groups:
- A social risk screener: This group received a standard risk-based assessment tool aimed at identifying existing material hardship that could impact their caregiving and overall wellbeing.
- A “resource menu" to indicate desired assistance: Participants in this group were provided with a curated menu of available resources, allowing them to indicate the types of assistance they wanted to receive without pre-requisite disclosure of risk
- No social assessment: This control group did not receive any form of social assessment, serving as a baseline for comparison.
All participants were equipped with access to various electronic resources and had the option for telephone-based personalized navigation support throughout the process. The researchers assessed the differences between the groups regarding their preferences for resources, the level of engagement with the navigation support, and the reported use of resources at a follow-up conducted 30 days after the initial intervention.
What this research adds:
The primary outcome was the desire for resources across any of the five domains, determined by an affirmative response to the question, "Would you like information about community resources that can help?" This applied to participants who screened positive for social risk and desired help, and those who chose a resource domain in the resource menu arm. Secondary outcomes included self-reported usage of the resource map, self-reported sharing of the resource map, and participation in resource navigation according to the randomization arm. The third randomization arm served as a control group to evaluate engagement with social resources and navigation without prior social assessment, providing a broader perspective for qualitative analysis, which was reported separately.
A significantly higher proportion of caregivers in the resource menu arm—nearly 10% more—reported desire for resources compared to the screening arm. When these results were stratified by preferred language, caregivers preferring a non-English language had 2.7 times greater odds of requesting resources when presented with the resource menu as opposed to the screening tool. These findings demonstrate that identifying caregiver's need for social resources is best done through a resource menu, allowing families to self-identify the services that best fit their circumstances without requiring them to disclose any social risk.
Clinical Implications
This multilingual randomized controlled trial (RCT) demonstrated a significant improvement in identifying caregivers' need for resources, without relying on social risk screening. Findings indicate that linking resource allocation to responses from social risk screenings often leads to missed opportunities to connect many caregivers with the assistance they require. Additionally, the results show that engagement in social care is influenced by caregivers' self-reported desire for help and the number of social domains in which they seek support.
The findings from this trial indicate a practical approach for pediatric healthcare systems aiming to implement social care programs. This approach includes:
- Needs-based social assessment tools, such as a resource menu, to identify the areas in which caregivers want assistance
- Providing electronic resources to everyone, along with tailored information and referrals for those who identify social need
- Offering personalized resource navigation for those who desire it.
This tiered approach promotes equity by empowering families to identify the services that best meet their needs without the requirement to disclose their social risks.
The results indicate that in pediatric healthcare settings, caregivers’ desire for social resources is more effectively identified using a resource menu that highlights prioritized areas of social need, rather than through screening for social risk factors. Additionally, the findings suggest that the level of social care can be tailored based on caregivers' responses to the resource menu and their preferences for personalized support. This approach fosters a more family-centered and equitable method of connecting resources.
Additional information and research related to this topic:
- Comparing Patient-Centered Approaches to Social Care in the Emergency Department: A Mixed-Method Randomized Controlled Trial – Annals of Emergency Medicine
- Barriers and facilitators to caregiver comfort with health‐related social needs data collection in the pediatric clinical setting - published in a special issue of Health Services Research
- Caregiver Perceptions of Social Need Documentation – JAMA Network Open
- Multilingual Research Strategies to Enhance Equity – JAMA Pediatrics
- Evaluation of a notes-based rapid qualitative analysis method to facilitate implementation- Implementation Science Communications
The authors acknowledge this study’s funders, the William T. Grant Foundation and the Emergency Medicine Foundation. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
This study was registered at ClinicalTrials.gov, #NCT05251311, https://www.clinicaltrials.gov/study/NCT05251311, on September 30, 2021.