G80 Using quality improvement to improve identification and support of families living in poverty in paediatric practice

• Published in: Archives of disease in childhood 2020-10, Vol.105 (Suppl 1), p.A25-A25
• Main Authors: Zhu, H, Ng, I, Bidgood, S, Cotterill, P, Morris, J, Okereafor, A, Sunderland, E, Singh, G
• Format: Article
• Language: English
• Subjects: Child Health; Child poverty; Children; Family (Sociological Unit); Feedback; Focus Groups; Medical personnel; Patients; Pediatrics; Physicians; Poverty; Quality control; Quality improvement; Risk factors; Social History
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2020-rcpch.61

AimsPoverty is the most important determinant of child health in the UK associated with adverse health, developmental, educational and long-term social outcomes. Despite growing levels of child poverty, paediatricians feel powerless when faced with it. Training gaps and underdeveloped pathways lead to missed opportunities to help impoverished families.Our aim was for >80% of doctors in the paediatric assessment unit to ask about child poverty as part of their routine clinical assessments and to signpost families to local resources where appropriate.MethodsMeasures:Percentage of doctors who asked about child poverty for the last patient clerked.Percentage of nurses and doctors aware of local resources for families living in poverty.Resources given and family feedback.This project was piloted in an area with 21% child poverty but is expanding to areas with greater deprivation. Stakeholder focus groups co-designed screening questions for (a) nurses: ‘how did you get to hospital/how will you get home?’ and for (b) doctors: ‘have you been on holiday in the last year?’ These questions were used in addition to identifying poverty risk factors from the family and social history, which included: single parents, unemployment, >3 young children, chronic health conditions and social worker involvement. When appropriate, the bespoke child poverty leaflet was discussed with parents offering local resources to help increase income, provide essentials and increase participation.ResultsAt baseline, no doctors screened for child poverty or advised on local resources. Plan-do-study-act cycles were conducted to test screening questions, increase colleagues’ buy-in and resource leaflet prescribing. The percentage screening for child poverty increased from 0% in March 2019 to an average of 84% in July-August 2019. The resource awareness percentage increased from 0% to 100%. Patient feedback was extremely positive: ‘thank you for being so thoughtful, you really helped me.’ConclusionPaediatricians can play a significant role in helping families living in poverty. This quality improvement project demonstrates one approach to asking about child poverty in routine clinical assessments and for offering local resources to help empower families. Further PDSA cycles are recommended to promote sustainability and advocate multidisciplinary progress of social paediatrics across children’s services in the UK.