Universal screening for social determinants of health in pediatric sickle cell disease: A quality‐improvement initiative

Abstract

Background Social determinants of health (SDoH) are socioeconomic factors that influence health outcomes. Guidelines recommend universal screening for SDoH at clinic visits; however, models that do not require additional resources are limited in subspecialty clinics. Individuals with sickle cell disease (SCD) face the burdens of chronic illness and often racial disparities, both of which may increase their vulnerability to adverse SDoH. Hematologists can impact both quality of life and clinical outcomes for their patients by implementing screening and referral programs addressing SDoH. Methods Through prospective, quality‐improvement methods, we introduced universal screening for SDoH into our pediatric hematology clinic. The intervention was a paper screener followed by a referral to local community organizations for the specific needs endorsed. The aims of this study were to determine the feasibility of universal screening for SDoH in a busy subspeciality clinic using pre‐existing resources to identify the needs of our patients and to facilitate referrals between our patients and community organizations via this low touch intervention. Results Between August 2017 and November 2018, 156 screens were completed. Sixty‐six percent were positive for at least one unmet social need for which 80% were referred to a relevant community organization. Forty‐five percent of patients available via follow‐up phone call reached out to the community organization. Conclusions There is a high burden of SDoH in families of children with SCD. Universal screening at a pediatric hematology clinic with the subsequent connection of patients with SCD to community resources is feasible using existing clinic resources.

Addressing unmet basic needs for children with sickle cell disease in the United States: clinic and staff perspectives

“…Caregivers’ “habit” of accessing support for basic needs through the SCD clinic speaks to a larger societal problem of systemic inequity and lack of a sufficient safety net that makes navigating services difficult—a process further exacerbated by managing a complex chronic illness. Assumptions about caregivers’ lack of self-sufficiency are contradicted by research in an urban pediatric hematology clinic, which demonstrated that 45% of families provided with a community referral had communicated with the community agency within 2 weeks of receiving the referral [ 9 ]. However, when help is offered, families may be reluctant to accept.…”

“…These sites serve as critical settings for such interventions given their typically centralized locations and capacity to have the resources to serve broad catchment areas. Yet, despite the demonstrated needs of the patient population [ 6 , 9 ], similar SDoH screening and referral models have not been as widely investigated or implemented in pediatric subspecialty care. Our study addresses this significant gap in the literature by assessing urban pediatric hematology clinic staff’s perspectives regarding barriers and facilitators to addressing unmet basic needs experienced by families with a child with SCD.…”

Household material hardships impact emergency department reliance in pediatric patients with sickle cell disease

“…The SDoH screener is a self‐reported, paper questionnaire completed by the families of patients with SCD during pediatric hematology clinic appointments. It was initiated during a quality improvement study to implement a validated screening for SDoH into our clinic for patients with SCD and to connect families in need with appropriate community resources 26 . Between August 2017 and June 2019, 83% of patients of all ages with SCD who had visited the hematology clinic in the study period had completed a screener (142 of 171).The pediatric hematology clinic serves approximately 180 patients with SCD from birth through 21 years of age.…”

Addressing Unmet Basic Needs for Children with Sickle Cell Disease: Clinic and Staff Perspectives

“…Assumptions about caregivers' lack of self-su ciency are contradicted by research in an urban pediatric hematology clinic, which demonstrated that 45% of families provided with a community referral had communicated with the community agency within two weeks of receiving the referral. 9 However, when help is offered, families may be reluctant to accept. In a study of caregivers' perspectives on provider assistance with community services, caregivers expressed feeling judged by those providing services, which compromised their motivation to contact and enroll in resources.…”

“…Yet, despite the demonstrated needs of the patient population, 6,9 similar SDoH screening and referral models have not been as widely investigated or implemented in pediatric subspecialty care. Our study addresses this signi cant gap in the literature by assessing urban pediatric hematology clinic staff's perspectives regarding barriers and facilitators to addressing unmet basic needs experienced by families with a child with SCD.…”