Effects of In-Person Assistance vs Personalized Written Resources About Social Services on Household Social Risks and Child and Caregiver Health

Abstract

IMPORTANCE Social and economic contexts shape children's short-and long-term health. Efforts to address contextual risk factors are increasingly incorporated into pediatric health care. OBJECTIVE To compare the effectiveness of 2 social risk-related interventions. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial included English-and/or Spanish-speaking caregiver-child dyads recruited from a pediatric urgent care clinic nested in a large,

Impact of an On-Site Versus Remote Patient Navigator on Pediatricians’ Referrals and Families’ Receipt of Resources for Unmet Social Needs

“…One study found that compared with patients who receive only written materials on community services, patients who receive on-site patient navigation services report reductions in unmet social needs and improvements in parent-reported child health outcomes, 10 while another similar study found no difference between the 2 groups. 11 As patient navigation interventions have expanded into pediatric health care delivery systems, issues have arisen regarding implementation barriers and utilization of these interventions. 12 Unfortunately, while in-person patient navigation is preferred by patients and physicians, it is often not feasible due to lack of financial resources and space.…”

Implementation Considerations for Social Determinants of Health Screening and Referral Interventions

“…The authors conducted a randomized clinical trial (RCT) in a pediatric urgent care clinic at an urban safety-net hospital to compare the efficacy of 2 interventions on reducing social risks and improving child and caregiver health 6 months after enrollment. 1 Caregiver-child dyads were screened for 18 social risk factors (eg, housing stability, food, employment) and randomized to receive either written information about available social services or written information plus in-person social services navigation assistance for their identified risks. Navigators assisted with scheduling appointments and completing forms and were in contact with caregivers via telephone, text message, or email every 2 weeks for up to 3 months.…”

“…The WE CARE screening consisted primarily of a self-reported 6-item social risk screener that triggered parental receipt of written resource sheets and social service applications only when parents indicated wanting help. The findings of the study by Gottlieb et al, 1 along with results from the 2015 trial, 3 suggest that pediatric practices, regardless of size and support staff, can address patients' unmet social needs by handing out high-quality written information. As Gottlieb housing voucher recipients compared the receipt of housing voucher information alone with housing voucher receipt and navigation assistance and found no difference in moving rates.…”

“…Overall, the study by Gottlieb et al 1 is an important contribution to our understanding of the effects of addressing social risks in the clinical environment. It also raises key questions that require further study.…”

“…al conclude, this relatively low-dose and low-cost intervention "could be effective for pediatric populations. "1 Unfortunately, the study by Gottlieb et al1 is not designed to address critical implementation factors necessary to transform clinical practice. Although testing the efficacy of the authors' interventions under controlled conditions is important, it is unclear how these results would translate in real-world pediatric primary care practice conditions.…”