Department of Family and Community Medicine, University of California, San Francisco2Center for Health and Community, University of California, San Francisco.
Department of Family and Community Medicine, University of California, San Francisco.
JAMA Pediatr. 2016 Nov 7;170(11):e162521. doi: 10.1001/jamapediatrics.2016.2521.
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.
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.
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).
Change in reported social needs and in caregiver assessment of child's overall health reported 4 months later.
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).
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.
clinicaltrials.gov Identifier: NCT01939704.
健康的社会决定因素既影响儿童的即时健康，也影响其一生的疾病风险。越来越多的儿科保健组织正在介入以解决家庭的社会逆境问题。然而，关于相关干预措施的有效性的证据很少。
评估社会需求筛查和面对面资源导航服务对社会需求和儿童健康的影响。
设计、设置和参与者：参与者根据就诊日期被随机分配到干预组或主动对照组。在入组后 4 个月观察到的主要结局包括照顾者报告的社会需求和儿童健康状况。招募工作于 2013 年 10 月 13 日至 2015 年 8 月 27 日在 2 家安全网医院的儿科初级保健和急诊诊所进行。参与者为陪同未成年子女进行非急性医疗就诊的英语或西班牙语照顾者。
在标准化筛查后，照顾者要么收到相关社区服务的书面信息（主动对照组），要么接受面对面的帮助以获取服务，并在需要时通过电话跟进提供进一步的帮助（导航干预组）。
4 个月后报告的社会需求变化和照顾者对儿童整体健康状况的评估。
在这项研究中，1809 名患者被平均分配到 2 个地点，其中 31.6%（n = 572）在初级保健诊所入组，68.4%（n = 1237）在急诊诊所入组。这些儿童主要为西班牙裔白人（50.9%[n = 921]）和非西班牙裔黑人（26.2%[n = 473]），平均（SD）年龄为 5.1（4.8）岁；50.5%（n = 913）为女性。基线时报告的社会需求数量从 0 到 14 项中的 11 项不等，平均（SD）为 2.7（2.2）。入组后 4 个月，干预组报告的社会需求数量比对照组减少更多，平均（SE）变化为-0.39（0.13）与 0.22（0.13）（P < .001）。此外，干预组的照顾者报告其子女的健康状况显著改善，平均（SE）变化为-0.36（0.05）与-0.12（0.05）（P < .001）。
据我们所知，这是第一项评估儿科社会需求导航项目健康结果的随机临床试验。与入组后 4 个月的主动对照组相比，干预组显著降低了家庭报告的社会需求，显著改善了照顾者报告的儿童整体健康状况。这些发现支持在儿科保健环境中解决社会需求的可行性和潜在效果。
clinicaltrials.gov 标识符：NCT01939704。
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