<p><strong>OBJECTIVE: </strong>Pediatric health systems are increasingly screening caregivers for unmet social needs. However, it remains unclear how best to connect families with unmet needs to available and appropriate community resources. We aimed to explore caregivers' perceived barriers to and facilitators of community resource connection.</p>

<p><strong>METHODS: </strong>We conducted semi-structured interviews with caregivers of pediatric patients admitted to one inpatient unit of an academic quaternary care children's hospital. All caregivers who screened positive for one or more unmet social needs on a tablet-based screener were invited to participate in an interview. Interviews were recorded, transcribed, and coded by two independent coders using content analysis, resolving discrepancies by consensus. Interviews continued until thematic saturation was achieved.</p>

<p><strong>RESULTS: </strong>We interviewed 28 of 31 eligible caregivers. Four primary themes emerged. First, caregivers of children with complex chronic conditions felt that competing priorities related to their children's medical care often made it more challenging to establish connection with resources. Second, caregivers cited burdensome application and enrollment processes as a barrier to resource connection. Third, caregivers expressed a preference for geographically tailored, web-based resources, rather than paper resources. Lastly, caregivers expressed a desire for ongoing longitudinal support in establishing and maintaining connections with community resources after their child's hospital discharge.</p>

<p><strong>CONCLUSION: </strong>Pediatric caregivers with unmet social needs reported competing priorities and burdensome application processes as barriers to resource connection. Electronic resources can help caregivers identify locally available services, but longitudinal supports may also be needed to ensure caregivers can establish and maintain linkages with these services.</p>

<p><strong>Importance: </strong>Many children and adolescents in the United States are exposed to neighborhood gun violence. Associations between violence exposure and children's short-term mental health are not well understood.</p>

<p><strong>Objective: </strong>To examine the association between neighborhood gun violence and subsequent mental health-related pediatric emergency department (ED) utilization.</p>

<p><strong>Design, Setting, and Participants: </strong>This location-based cross-sectional study included 128 683 ED encounters for children aged 0 to 19 years living in 12 zip codes in Philadelphia, Pennsylvania, who presented to an urban academic pediatric ED from January 1, 2014, to December 31, 2018. Children were included if they (1) had 1 or more ED visits in the 60 days before or after a neighborhood shooting and (2) lived within a quarter-mile radius of the location where this shooting occurred. Analysis began August 2020 and ended May 2021.</p>

<p><strong>Exposure: </strong>Neighborhood violence exposure, as measured by whether a patient resided near 1 or more episodes of police-reported gun violence.</p>

<p><strong>Main Outcomes and Measures: </strong>ED encounters for a mental health-related chief complaint or primary diagnosis.</p>

<p><strong>Results: </strong>A total of 2629 people were shot in the study area between 2014 and 2018, and 54 341 children living nearby had 1 or more ED visits within 60 days of a shooting. The majority of these children were Black (45 946 [84.5%]) and were insured by Medicaid (42 480 [78.1%]). After adjusting for age, sex, race and ethnicity, median household income by zip code, and insurance, children residing within one-eighth of a mile (2-3 blocks) of a shooting had greater odds of mental health-related ED presentations in the subsequent 14 days (adjusted odds ratio, 1.86 [95% CI, 1.20-2.88]), 30 days (adjusted odds ratio, 1.49 [95% CI, 1.11-2.03]), and 60 days (adjusted odds ratio, 1.35 [95% CI, 1.06-1.72]).</p>

<p><strong>Conclusions and Relevance: </strong>Exposure to neighborhood gun violence is associated with an increase in children's acute mental health symptoms. City health departments and pediatric health care systems should work together to provide community-based support for children and families exposed to violence and trauma-informed care for the subset of these children who subsequently present to the ED. Policies aimed at reducing children's exposure to neighborhood gun violence and mitigating the mental symptoms associated with gun violence exposure must be a public health priority.</p>

<p><strong>OBJECTIVES: </strong>To develop and test the feasibility of a caregiver self-administered social needs screener, a Web-based searchable community resource map, and a process map for implementation of these tools as part of social needs screening and referral on a pediatric inpatient unit.</p>

<p><strong>METHODS: </strong>A multidisciplinary team used quality improvement methodology to develop an electronic social needs screener, resource map Web site, and electronic health record enhancements. A process map for implementation of these tools was refined through plan-do-study-act cycles before full implementation. Weekly measures included the number of eligible caregivers screened, prevalence of reported social needs, and use of social work resources.</p>

<p><strong>RESULTS: </strong>During the 22-week study period, 147 caregivers were screened and 2 declined to participate. Thirty-four percent of caregivers endorsed ≥1 social need. The most common needs identified were depressive symptoms (23%), food insecurity (19%), and need for assistance with utilities (10%). All participants received information about the resource map, and 99% of caregivers with an identified need met with a social worker during their admission.</p>

<p><strong>CONCLUSIONS: </strong>Using quality improvement methodology and technology, the team implemented a new standardized process for addressing social needs on an inpatient unit. This led to identification of social needs in more than one-third of caregivers screened and provision of resource map information to all caregivers. These findings reinforce the importance of standardized assessment of social needs in the pediatric inpatient setting. The role of technology, including resource maps and electronic health record enhancements, was highlighted.</p>

<p><strong>Importance: </strong>The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an important source of nutritional support and education for women and children living in poverty; although WIC participation confers clear health benefits, only 50% of eligible women and children currently receive WIC. In 2010, Congress mandated that states transition WIC benefits by 2020 from paper vouchers to electronic benefits transfer (EBT) cards, which are more convenient to use, are potentially less stigmatizing, and may improve WIC participation.</p>

<p><strong>Objective: </strong>To estimate the state-level association between transition from paper vouchers to EBT and subsequent WIC participation.</p>

<p><strong>Design, Setting, and Participants: </strong>This economic evaluation of state-level WIC monthly benefit summary administrative data regarding participation between October 1, 2014, and November 30, 2019, compared states that did and did not implement WIC EBT during this time period. Difference-in-differences regression modeling allowed associations to vary by time since policy implementation and included stratified analyses for key subgroups (pregnant and postpartum women, infants younger than 1 year, and children aged 1-4 years). All models included dummy variables denoting state, year, and month as covariates. Data analyses were performed between March 1 and June 15, 2020.</p>

<p><strong>Exposures: </strong>Statewide transition from WIC paper vouchers to WIC EBT cards, specified by month and year.</p>

<p><strong>Main Outcomes and Measures: </strong>Monthly number of state residents enrolled in WIC.</p>

<p><strong>Results: </strong>A total of 36 states implemented WIC EBT before or during the study period. EBT and non-EBT states had similar baseline rates of poverty and food insecurity. Three years after statewide WIC EBT implementation, WIC participation increased by 7.78% (95% CI, 3.58%-12.15%) in exposed states compared with unexposed states. In stratified analyses, WIC participation increased by 7.22% among pregnant and postpartum women (95% CI, 2.54%-12.12%), 4.96% among infants younger than 1 year (95% CI, 0.95%-9.12%), and 9.12% among children aged 1 to 4 years (95% CI, 3.19%-15.39%; P for interaction = .20). Results were robust to adjustment for state unemployment and poverty rates, population, and Medicaid expansion status.</p>

<p><strong>Conclusions and Relevance: </strong>In this study, the transition from paper vouchers to WIC EBT was associated with a significant and sustained increase in enrollment. Interventions that simplify the process of redeeming benefits may be critical for addressing low rates of enrollment in WIC and other government benefit programs.</p>

<p><strong>BACKGROUND: </strong>Advocacy regarding child health policy is a core tenet of pediatrics. Previous research has demonstrated that most pediatric providers believe collective advocacy and political involvement are essential aspects of their profession, but less is known about how pediatric providers engage with families about policy issues that impact child health. The objectives of this study were to examine providers' perceptions and practices with regards to discussing health policy issues with families and to identify provider characteristics associated with having these discussions.</p>

<p><strong>METHODS: </strong>In this cross-sectional mixed methods study, pediatric resident physicians, attending physcians, and nurse practitioners at primary care clinics within a large academic health system were surveyed to assess (1) perceived importance of, (2) frequency of, and (3) barriers to and facilitators of health policy discussions with families. Multivariable ordinal regression was used to determine provider characteristics (including demographics, practice location, and extent of civic engagement) associated with frequency of these discussions. A subset of providers participated in subsequent focus groups designed to help interpret quantitative findings.</p>

<p><strong>RESULTS: </strong>The overall survey response rate was 155/394 (39%). The majority of respondents (76%) felt pediatricians should talk to families about health policy issues affecting children, but most providers (69%) reported never or rarely having these discussions. Factors associated with discussing policy issues included being an attending physician/nurse practitioner (OR 8.22, 95% CI 2.04-33.1) and urban practice setting (OR 3.85, 95% CI 1.03-14.3). Barriers included feeling uninformed about relevant issues and time constraints. In provider focus groups, four key themes emerged: (1) providers felt discussing policy issues would help inform and empower families; (2) providers frequently discussed social service programs, but rarely discussed policies governing these programs; (3) time constraints and concerns about partisan bias were a barrier to conversations; and (4) use of support staff and handouts with information about policy changes could help facilitate more frequent conversations.</p>

<p><strong>CONCLUSIONS: </strong>Pediatric providers felt it was important to talk to families about child health policy issues, but few providers reported having such conversations in practice. Primary care practices should consider incorporating workflow changes that promote family engagement in relevant health policy discussions.</p>

<p><strong>OBJECTIVES: </strong>The American Academy of Pediatrics recommends that all pediatricians screen for social determinants of health to identify families in need and connect them to available resources. We examined pediatric residents' screening practices for social needs in different clinical settings and explored the influence of electronic health record (EHR) prompts on screening.</p>

<p><strong>METHODS: </strong>In this cross-sectional study, pediatric residents participated in a brief electronic survey assessing (1) screening practices for unmet social needs and (2) perceived barriers to and facilitators of routine screening in the inpatient and outpatient settings. The differences in screening by care setting were assessed by using Fisher's exact test. Mixed-effects logistic regression was used to examine the association between EHR prompts and resident screening practices.</p>

<p><strong>RESULTS: </strong>Ninety-two pediatric residents (64% of the residency program) responded to the survey. Respondents reported significantly higher rates of social needs screening in the outpatient as compared with the inpatient setting (98% vs 37%; &lt; .001). Residents cited time constraints, lack of knowledge about available resources, and discomfort with screening questions as barriers to screening in both settings. Residents were more likely to screen for social needs when screening questions were embedded in the EHR (odds ratio = 9.6; 95% confidence interval: 6.7-13.9).</p>

<p><strong>CONCLUSIONS: </strong>Pediatric residents were more likely to screen for unmet social needs in the outpatient than in the inpatient setting despite reporting similar barriers to screening in both settings. EHR-based social needs screening templates could be used to increase rates of screening and reach additional families in need.</p>

<p><strong>BACKGROUND: </strong>National organizations recommend pediatricians screen for food insecurity (FI). Although there has been growing research in urban practices, little research has addressed FI screening in suburban practices. We evaluated the feasibility, acceptability, and impact of screening in suburban practices.</p>

<p><strong>METHODS: </strong>We conducted a mixed methods study that implemented FI screening in 6 suburban pediatric primary care practices. We included all children presenting for either a 2-, 15-, or 36-month well-child visit (N = 5645). Families who screened positive were eligible to be referred to our community partner that worked to connect families to the Supplemental Nutrition Assistance Program. We conducted focus groups with clinicians to determine their perceptions of screening and suggestions for improvement.</p>

<p><strong>RESULTS: </strong>Of the 5645 children eligible, 4371 (77.4%) were screened, of which 122 (2.8%) screened positive for FI (range: 0.9%-5.9% across practices). Of the 122 food-insecure families, only 1 received new Supplemental Nutrition Assistance Program benefits. In focus groups, 3 themes emerged: (1) Time and workflow were not barriers to screening, but concerns about embarrassing families and being unable to provide adequate resources were; (2) Clinicians reported that parents felt the screening showed caring, which reinforced clinicians' continued screening; (3) Clinicians suggested implementing screening before the visit.</p>

<p><strong>CONCLUSIONS: </strong>We found it is feasible and acceptable for clinicians to screen for FI in suburban practices, but the referral method used in this study was ineffective in assisting families in obtaining benefits. Better approaches to connect families to local resources may be needed to maximize the effectiveness of screening in suburban settings.</p>

<p><strong>BACKGROUND: </strong>Food insecurity (FI) remains a major public health problem. With the rise in suburban poverty, a greater understanding of parents' experiences of FI in suburban settings is needed to effectively screen and address FI in suburban practices.</p>

<p><strong>METHODS: </strong>We conducted 23 semistructured interviews with parents of children &lt;4 years of age who presented for well-child care in 6 suburban pediatric practices and screened positive for FI. In the interviews, we elicited parents' perceptions of screening for FI, how FI impacted the family, and recommendations for how practices could more effectively address FI. All interviews were audio recorded and transcribed. We used a modified grounded theory approach to code the interviews inductively and identified emerging themes through an iterative process. Interviews continued until thematic saturation was achieved.</p>

<p><strong>RESULTS: </strong>Of the 23 parents interviewed, all were women, with 39% white and 39% African American. Three primary themes emerged: Parents expressed initial surprise at screening followed by comfort discussing their unmet food needs; parents experience shame, frustration, and helplessness regarding FI, but discussing FI with their clinician helped alleviate these feelings; parents suggested practices could help them more directly access food resources, which, depending on income, may not be available to them through government programs.</p>

<p><strong>CONCLUSIONS: </strong>Although most parents were comfortable discussing FI, they felt it was important for clinicians to acknowledge their frustrations with FI and facilitate access to a range of food resources.</p>