Findings support the importance of integrating psychosocial risk screening into clinical care and offer strategies for implementation of screening across a range of settings.

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Objective This cross-sectional study quantified differences in (a) social determinants of health (SDOH) and perceived changes in SDOH during the 2019 novel coronavirus (COVID-19) pandemic and (b) COVID-19 psychosocial impacts across four groups: (a) non-Hispanic White (NHW) parents of children with asthma, (b) Black, Indigenous, or other People of Color (BIPOC) parents of healthy children, (c) BIPOC parents of children with asthma, and (d) NHW parents of healthy children (referent). The NIMHD Framework was used to identify SDOHs that may change for families during COVID-19. Methods Parents were recruited via Prolific (N = 321) and completed questions about COVID-19 family impacts on employment, income, access to food and healthcare, and psychosocial functioning, including discrimination. It was hypothesized that NHW families of children with asthma and BIPOC families would endorse greater negative outcomes relative to NHW parents of healthy children. Results BIPOC families experienced greater food insecurity and discrimination relative to NHW parents of healthy children. When compared with the NHW healthy group, COVID-19 resulted in greater parent-reported resource losses for both BIPOC groups and greater reductions in healthcare access for both asthma groups. Children with asthma and BIPOC children had greater distress surrounding COVID-19. BIPOC and NHW parents of children with asthma reported greater worries about resource losses due to COVID-19. Conclusions The pandemic is widening inequities for BIPOC families, especially for families of children with asthma. These results highlight the need for interventions that address the needs of underserved communities, providing the infrastructure, policies, and supports needed to reduce health inequities during and after COVID-19.

There were 2 related objectives of this qualitative study focused on caregivers of children with sickle cell disease (SCD): (1) to assess caregiver perspectives on the acceptability and utility of the Psychosocial Assessment Tool (PAT) as a screener of family psychosocial risk in pediatric SCD and (2) to examine caregiver perspectives on psychosocial risk factors, as well as their resiliencies and coping strategies, to help inform possible modifications to the PAT. Caregivers (n ϭ 43) of youth with SCD completed the PAT to assess feasibility of administration and a subset (n ϭ 22) completed a qualitative interview organized around principles of cognitive interviewing for instrument validation. Constant comparative analyses involved coding interviews, organizing coding categories into themes, and systematically reintegrating themes regarding caregiver perspectives. Caregivers had positive reactions to the PAT, including its ability to broadly assess risk factors, potential utility in helping connect families to resources, and the brevity and ease of completion. Caregivers described salient family stressors as well as adaptive coping strategies that generally aligned well with areas assessed by the PAT, and also provided feedback that can help inform modification of the PAT to better fit the SCD population. Families of youth with SCD face significant psychosocial stressors but demonstrate resiliency in using adaptive coping strategies. Study results support the continuing development of the PAT as a family psychosocial risk screener in pediatric SCD that can enhance the delivery of evidence-based care and reduce health disparities.

Families coping with sickle cell disease (SCD) often face heightened psychosocial risk factors, and research in pediatric SCD has often focused more on this area than resiliency factors. The aim of this study was to gain a better understanding of family resiliency in SCD based on caregiver perspectives. A secondary qualitative analysis was conducted with data from a mixed-methods study of caregivers of youth with SCD (n=22). Qualitative analyses involved coding based on 2 resiliency frameworks, organizing coding categories into themes, and systematically reintegrating these themes into a conceptualization that reflected family resiliency. Themes aligned well with the resiliency frameworks and related to family belief systems and meaning-making around SCD (acceptance of SCD, positive attitude, religious faith), family organization and adaptation (flexibility, stability, social supports), and the importance of communication and problem-solving. Study findings emphasize the importance of assessing resilience in families of youth with SCD and suggest the potential clinical benefits of developing psychosocial interventions based on family strengths.