Screening for Social Determinants of Health Among Children and Families Living in Poverty: A Guide for Clinicians

Abstract

Approximately 20% of all children in the United States live in poverty, which exists in rural, urban, and suburban areas. Thus, all child health clinicians need to be familiar with the effects of poverty on health and to understand associated, preventable, and modifiable social factors that impact health. Social determinants of health are identifiable root causes of medical problems. For children living in poverty, social determinants of health for which clinicians may play a role include the following: child maltreatment, child care and education, family financial support, physical environment, family social support, intimate partner violence, maternal depression and family mental illness, household substance abuse, firearm exposure, and parental health literacy. Children, particularly those living in poverty, exposed to adverse childhood experiences are susceptible to toxic stress and a variety of child and adult health problems, including developmental delay, asthma and heart disease. Despite the detrimental effects of social determinants on health, few child health clinicians routinely address the unmet social and psychosocial factors impacting children and their families during routine primary care visits. Clinicians need tools to screen for social determinants of health and to be familiar with available local and national resources to address these issues. These guidelines provide an overview of social determinants of health impacting children living in poverty and provide clinicians with practical screening tools and resources.

The Child Opportunity Index and Disparities in Pediatric Asthma Hospitalizations Across One Ohio Metropolitan Area, 2011-2013

“…(30) While social risk assessment is increasingly upheld as a critical component of preventive patient care, no singular “right” way to assess (or intervene) has been established. (31, 32) Given these challenges, it is possible that area-based measures or indices could help frame or inform patient-level social histories. We previously showed significant correlations between area-level and family-reported measures of socioeconomic status within a cohort of children hospitalized with asthma.…”

Developing Electronic Health Record (EHR) Strategies Related to Health Center Patients' Social Determinants of Health

“…23,30-39 Many CHCs already try to address patients’ SDH, but their approaches to doing so have historically been manual and ad-hoc. 40-44 …”

Research Review: Intergenerational transmission of disadvantage: epigenetics and parents' childhoods as the first exposure

“…Research also showed that household and neighborhood poverty are related to stress (Schulz et al., ), and the cumulative effect of stressors such as housing or food insecurity, child abuse or neglect, parental substance abuse, and violence – factors associated with poverty (Evans & English, ) – can induce a toxic stress response in young children, which can lead to long‐term changes in brain structure and function in infancy and early childhood (McEwen et al., ; Shonkoff et al., , ). Neighborhood poverty was also shown to be correlated with poor nutrition and obesity (Morland, Roux, & Wing, ), which combined with risk factors such as community violence and interpersonal and environmental trauma prevalent in areas of poverty, contribute to chronic physical and mental health problems across the life course (Chung et al., ; Curry, Latkin, & Davey‐Rothwell, ; Leventhal & Brooks‐Gunn, ; Seligman, Laraia, & Kushel, ). The structural perspective also emphasizes that the lack of access to adequate health care, particularly preventative health care, can exacerbate these problems.…”