A Team Care Screener to Address Social Determinants of Health in Pediatric Primary Care

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Health encompasses our lives in various ways; where we live, how we work, and how we play. These differentiating factors, or “social determinants”, may impact physical and mental health in a prominent manner. Screening for social determinants of health in pediatric primary care may help to identify important areas to intervene with families to address barriers to receiving care and improve health outcomes. East Tennessee State University (ETSU) Pediatrics aimed to find the prevalence of varying social determinants in their patient population through a 6-item screening tool—the Team Care screener. A Team Care screener was administered to the caregiver(s) of every child that came into the clinic for a newborn appointment, six month appointment, or one year well child examination. Caregivers responded with Yes or No to the screener's six items concerning the following: (1) ability to understand written and spoken English; (2) experiencing financial stress related to housing, food, and utilities; (3) stress around substance use; (4) incidents of domestic abuse; (5) feelings of depression and possible suicidal ideation; and (6) if transportation has been a barrier to attending medical appointments. After the screener was collected, if any social determinants were marked as Yes on the screener, a needs assessment was completed with the caregiver(s). The family then received resources to address needs at the appointment or by phone follow up, if applicable. This procedure is ongoing at the clinic. Results indicated that of the 1,009 Team Care screeners administered over a four-month period, 15% (n=153) of patients' caregivers reported a deficit in at least one social determinant. More specifically, 8% (n=79) endorsed experiencing financial stress, 5% (n=49) reported strain from acquiring transportation to appointments, 4% (n=17) expressed concerns related to substance use, 1% (n=14) noted difficulties with comprehending English, and less than 1% (n=6) reported possible incidents of domestic abuse. After discussion with caregivers, the most frequently reported stressors were determined to be access to adequate food, housing, and utilities as well as distress concerning transportation to medical appointments. Overall, our results suggest that a large portion of the patient population demonstrates varying social needs which have the potential to influence health outcomes. The Team Care screener has elucidated which patients are at particular risk, which allows clinic staff to provide more efficient patient-centered care.


Johnson City, TN

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