No abstract

With increasing numbers of elderly people, and the escalating costs of health care, screening becomes increasingly important for identifying those older people with social health care needs who appear in their primary care physicians' offices. Many people are not aware of available social services. Families with serious social problems are not finding the help they need. The aim of this study was to develop and refine a questionnaire as a screening tool to identify elderly outpatients in primary care settings who are at high risk for psychological, social or environmental needs. This study identified those ten factors at each site which were most indicative that further intervention was needed. There were consistencies among the coordinators across sites in terms of what factors triggered intervention. Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) were more likely to be predictive of the coordinator's intervention than were other factors.

A comprehensive pediatric care program was offered to a sample of urban poor families, with special attention being paid those families who had indicated that they would be "hard to reach" or who had a specific social problem. The majority of families approached readily accepted this offer of medical care. With considerable further effort 75% of the hard-to-reach families could be brought into the program. The presence of a specific social problem, illegitimacy, while not precluding a family's being enrolled, did decrease participation and require more effort. Residential mobility and family disorganization were the major handicaps encountered. Race, mother's education, and children's age also influenced the outcome. These efforts, while rewarding, entailed considerable time and expense; whether this is worthwhile depends on the demonstration of actual benefits of comprehensive care to the families.