A Broad-Based Approach to Social Needs Screening in a Pediatric Primary Care Network

• Published in: Academic pediatrics 2021-05, Vol.21 (4), p.694-701
• Main Authors: Bittner, Jane C., Thomas, Nicole, Correa, Emily Trudell, Hatoun, Jonathan, Donahue, Sara, Vernacchio, Louis
• Format: Article
• Language: English
• Subjects: pediatrics; primary care; screening; social needs
• ISSN: 1876-2859; 1876-2867
• DOI: 10.1016/j.acap.2020.08.021

In 2016, the American Academy of Pediatrics recommended universally screening patients for social needs, and in 2018, a quality measure for social needs screening was included in some Massachusetts Medicaid contracts. However, exact guidelines for screening were not provided. We describe the results and implications from a broad-based health-related social needs (HRSN or “social needs”) screening program within our large, pediatric primary care network. We adapted items from The Health Leads toolkit to create our network's screening tool: The Health Needs Assessment (HNA). We trained staff to use the tool and provided staff with resources to assist families with their needs. All patients with a primary care physician in the network were eligible to complete an HNA. We calculated descriptive statistics and estimated the risk of identifying a social need using multivariable regression analyses. Between June 2018 and May 2019, 100,097 patients completed an HNA; 8% of patients identified a social need, and 33% of those patients requested assistance with the need(s). The multivariate analysis revealed an association between several patient characteristics—health insurance type, age, median household income by zip code, complex chronic conditions, race/ethnicity—and identifying a social need. Our large, pediatric primary care network successfully instituted a broad-based HRSN screening program in response to state and national screening recommendations. We observed a low prevalence of reported social needs and a propensity to forego assistance. Additional research is needed to understand the barriers around the disclosure of social needs and requests for assistance.