A Randomized Trial on Screening for Social Determinants of Health: the iScreen Study

Abstract

BACKGROUND: There is growing interest in clinical screening for pediatric social determinants of health, but little evidence on formats that maximize disclosure rates on a wide range of potentially sensitive topics. We designed a study to examine disclosure rates and hypothesized that there would be no difference in disclosure rates on face-to-face versus electronic screening formats for items other than highly sensitive items. METHODS: We conducted a randomized trial of electronic versus face-to-face social screening formats in a pediatric emergency department. Consenting English-speaking and Spanish-speaking adult caregivers familiar with the presenting child’s household were randomized to social screening via tablet computer (with option for audio assist) versus a face-to-face interview conducted by a fully bilingual/bicultural researcher. RESULTS: Almost all caregivers (96.8%) reported at least 1 social need, but rates of reporting on the more sensitive issues (household violence and substance abuse) were significantly higher in electronic format, and disclosure was marginally higher in electronic format for financial insecurity and neighborhood and school safety. There was a significant difference in the proportion of social needs items with higher endorsement in the computer-based group (70%) than the face-to-face group (30%). CONCLUSIONS: Pediatric clinical sites interested in incorporating caregiver-reported socioeconomic, environmental, and behavioral needs screening should consider electronic screening when feasible, particularly when assessing sensitive topics such as child safety and household member substance use.

Caregiver Opinion of In-Hospital Screening for Unmet Social Needs by Pediatric Residents

“…4,13,31 Screening for unmet social needs has been successfully implemented in a variety of ways—including waiting room paper-based screening instruments, 20,32,33 computer-based questionnaires, 22,23,25 and the physician’s social history 30 —and integrated into the electronic health record. 34 Furthermore, with new advocacy training requirements for all US pediatric residency programs, 35 it is possible that newly trained pediatricians will consider screening for unmet social needs a routine part of pediatric practice.…”

“…20,22,23 Previous research in this area has been limited to the outpatient setting and most often utilized computer-based screening. 20,22,23,25 Family opinion of physician screening for unmet social needs in the setting of an acute illness, such as a hospitalization, remains unknown. In addition, since the previous studies did not survey families who were not screened, it is unknown whether opinions about physician screening for unmet screening might change after having been screened by a physician.…”

Perspectives in Primary Care: A Conceptual Framework and Path for Integrating Social Determinants of Health Into Primary Care Practice

“…Many primary care clinics have developed their own systems for collecting some individual-level SDH data from patients, but few are using validated instruments to standardize data collection and integration into EHRs. [42][43][44] Community-level SDH (or community vital signs) are readily available in national data sets, and it is technically possible to integrate these community-level SDH into a patient's medical record using current geocoding technologies; however, community vital signs have not yet been widely imported into primary care data systems. 25 Once we make progress toward routine collection of SDH data, the second step is making the data available and useful in ways that enhance care (the right data, at the right time, in the right place).…”

Child Health Disparities: What Can a Clinician Do?

“…The iScreen study compared a screener for social determinants of health on a computer tablet or face-to-face in a pediatric emergency department finding greater disclosure in electronic format. 25 …”