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Cited by 419Child and Adolescent HealthFood Security and Health in Diverse PopulationsHealth disparities and outcomes

Effects of Social Needs Screening and In-Person Service Navigation on Child Health: A Randomized Clinical Trial

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Gottlieb, Laura M., Hessler, Danielle, Long, Dayna, Laves, Ellen, Burns, Abigail R., Amaya, Anais, Sweeney, Patricia, Schudel, Christine +1 more·2016·JAMA Pediatrics
DOI 10.1001/jamapediatrics.2016.2521
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Abstract

Importance: Social determinants of health shape both children's immediate health and their lifetime risk for disease. Increasingly, pediatric health care organizations are intervening to address family social adversity. However, little evidence is available on the effectiveness of related interventions. Objective: To evaluate the effects of social needs screening and in-person resource navigation services on social needs and child health. Design, Setting, and Participants: Patients were randomized to intervention or active control conditions by the day of the week. Primary outcomes observed at 4 months after enrollment included caregivers' reports of social needs and child health status. Recruitment occurred between October 13, 2013, and August 27, 2015, in pediatric primary and urgent care clinics in 2 safety-net hospitals. Participants were English-speaking or Spanish-speaking caregivers accompanying minor children to nonacute medical visits. Interventions: After standardized screening, caregivers either received written information on relevant community services (active control) or received in-person help to access services with follow-up telephone calls for further assistance if needed (navigation intervention). Main Outcomes and Measures: Change in reported social needs and in caregiver assessment of child's overall health reported 4 months later. Results: Among 1809 patients enrolled in the study, evenly split between the 2 sites, 31.6% (n = 572) were enrolled in a primary care clinic and 68.4% (n = 1237) were enrolled in an urgent care setting. The children were primarily Hispanic white individuals (50.9% [n = 921]) and non-Hispanic black individuals (26.2% [n = 473]) and had a mean (SD) age of 5.1 (4.8) years; 50.5% (n = 913) were female. The reported number of social needs at baseline ranged from 0 to 11 of 14 total possible items, with a mean (SD) of 2.7 (2.2). At 4 months after enrollment, the number of social needs reported by the intervention arm decreased more than that reported by the control arm, with a mean (SE) change of -0.39 (0.13) vs 0.22 (0.13) (P < .001). In addition, caregivers in the intervention arm reported significantly greater improvement in their child's health, with a mean (SE) change of -0.36 (0.05) vs -0.12 (0.05) (P < .001). Conclusions and Relevance: To our knowledge, this investigation is the first randomized clinical trial to evaluate health outcomes of a pediatric social needs navigation program. Compared with an active control at 4 months after enrollment, the intervention significantly decreased families' reports of social needs and significantly improved children's overall health status as reported by caregivers. These findings support the feasibility and potential effect of addressing social needs in pediatric health care settings. Trial Registration: clinicaltrials.gov Identifier: NCT01939704.

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  • The social risk survey instrument used in this study was sourced from a previous social risk factor screening trial.

    “The survey instrument was sourced from a previous social risk factor screening trial and is shown in Appen- dix SA. 11,12”

    From Structured and unstructured social risk factor documentation in the electronic health record underestimates patients’ self-reported risks (2024) · cites this paper as [11]

  • Quantitative research has found health effects are not unambiguously mediated by social services connections or changes in social risk.

    “quantitative research has found health effects are not unambiguously mediated by social services connections or changes in social risk.”

    From Revising the logic model behind health care's social care investments (2024) · cites this paper as [37]

  • An RCT of pediatric primary and urgent care-based social services navigation showed decreases in social risks and improvements in health, but improvements in parent-reported child health outcomes were not mediated by changes in families' social risks.

    “A randomized controlled trial (RCT) examining both pediatric primary and urgent care–based social services navigation program showed that although the intervention was associated with both decreases in social risks and improvements in health, improvements in parent‐reported child health outcomes were not mediated by changes in families’ social risks 37”

    From Revising the logic model behind health care's social care investments (2024) · cites this paper as [37]

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Research works printed but not linked: 1

  1. [30]30. Minkovitz CS, O'Campo PJ, Chen YH, Grason HA. Associations between maternal and child health status and patterns of medical care use. Ambul Pediatr. 2002;2(2):85-92.

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Authors
Gottlieb, L. M., Hessler, D., Long, D., Laves, E., Burns, A. R., Amaya, A., Sweeney, P., Schudel, C., & Adler, N. E.
Affiliations
  • University of California, San Francisco (US)
  • University of California System (US)
ORCID
Venue
JAMA Pediatrics
Publisher
American Medical Association (AMA)
Published
2016-11-07
Volume
170
Issue
11
Pages
e162521
ISSN
  • 1072-4710 (ISSN-L)
  • 2168-6203
DOI
10.1001/jamapediatrics.2016.2521
OpenAlex
W2517444490
Semantic Scholar
11892a92c58e5321c6e8b5300b4df8623c76a43c
Cited by
419
References
44
Citations by year
2026: 33 · 2025: 53 · 2024: 54 · 2023: 55 · 2022: 49 · 2021: 45 · 2020: 47 · 2019: 33 · 2018: 33 · 2017: 15 · 2016: 2
FWCI
51.54
Type
journal article
Language
en
Open access
Locations
  • Archives of Pediatrics and Adolescent Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
  • Health Sciences › Health Professions › General Health Professions › Food Security and Health in Diverse Populations
  • Social Sciences › Health › Health disparities and outcomes
Keywords
social needs screening, social determinants of health, child health, pediatric primary care, urgent care, safety-net hospitals, Hispanic children, non-Hispanic Black children, health equity
MeSH terms
Child Health, Child, Female, Health Promotion, Health Status, Humans, Male, Mass Screening, Primary Health Care, Social Support, Social Work, Caregivers, Needs Assessment

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