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Cited by 643Child and Adolescent HealthFood Security and Health in Diverse PopulationsPublic Health and Social Inequalities

Addressing Social Determinants of Health at Well Child Care Visits: A Cluster RCT

Open access
Garg, Arvin, Toy, Sarah, Tripodis, Yorghos, Silverstein, Michael, Freeman, Elmer·2015·Pediatrics
DOI 10.1542/peds.2014-2888PMC PMC4306802
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Abstract

To evaluate the effect of a clinic-based screening and referral system (WE CARE) on families' receipt of community-based resources for unmet basic needs.

Integrity signals

Registry

Crossref · 10.1542/peds.2014-2888

Cites

53 of 53 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

2 of 26 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Findingnone given

    There was no effect modification on any outcome measure by study wave or maternal depression.

    “There was no effect modification on any outcome measure by study wave or maternal depression.”
    Quote in the paperNot a substantial claim
  • Findingown data

    WE CARE children had greater odds of being enrolled in child care (aOR = 6.3; 95% CI, 1.5-26.0).

    “WE CARE children had greater odds of being in child care (aOR = 6.3; 95% CI, 1.5-26.0).”
    • Also stated in: § FIGURE 1 · plain
      “WE CARE children had greater odds of being enrolled in a child care (aOR = 6.3; 95% CI, 1.5-26.0)”
    Quote in the paperSubstantial claim
  • Findingown data

    For each type of need, WE CARE mothers had significantly greater adjusted odds of receiving a referral.

    “For each type of need, WE CARE mothers had significantly greater adjusted odds of receiving a referral (Table 3).”
    Quote in the paperSubstantial claim
  • Findingown data

    At the 12-month well child care visit, more WE CARE mothers had enrolled in at least one new community resource than control mothers (39% vs 24%; aOR = 2.1; 95% CI, 1.2-3.7).

    “At the 12-month visit, more WE CARE mothers had enrolled in a new community resource (39% vs 24%; aOR = 2.1; 95% CI, 1.2-3.7).”
    • Also stated in: § FIGURE 1 · plain
      “At the 12-month well child care visit, more WE CARE mothers had enrolled in $1 new resource (39% vs 24%; aOR = 2.1; 95% CI, 1.2-3.7).”
    Quote in the paperSubstantial claim
  • Findingown data

    WE CARE mothers had greater odds of being employed or enrolled in a job training program (aOR = 44.4; 95% CI, 9.8-201.4).

    “WE CARE mothers had greater odds of being employed (aOR = 44.4;95% CI, 9.8-201.4).”
    • Also stated in: § FIGURE 1 · plain
      “WE CARE mothers had greater odds of being employed or enrolled in a job training program (aOR = 44.4;95% CI, 9.8-201.4)”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 25
  • May combine two claims. 14

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Food insecurity is assessed on the 18-item US Food Security Scale, a valid and reliable instrument with established clinical cutoffs.

    “Within the Children's HealthWatch survey, food insecurity is assessed on the 18-item US Food Security Scale, a valid and reliable instrument with established clinical cutoffs.23,25”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [23] Frank, 2010, Cumulative hardship and wellness of low-income, young children: multisite surveillance study., Pediatrics source
    • cites [25] Cook, 2006, Child food insecurity increases risks posed by household food insecurity to young children’s health., J Nutr source

      The paper describes the US Food Security Scale as an 18-question instrument and says the study derived food-security status from it using established procedures (Methods; Exposure variable, page not provided). It does not establish that the scale is valid and reliable or that its classification thresholds are clinical cutoffs. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    Social determinants-the circumstances in which people live and work-affect health.

    “There is nearly universal agreement in the scientific and public health communities that social determinants, 1 the circumstances in which people live and work, affect health. 1”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [1] Marmot, 2006 source

  • May combine two claims.

    Findingown data

    More than 90% of subjects reported at least one unmet basic need at baseline, 68% reported at least two needs, and 39% reported at least three needs.

    “More than 90% of subjects reported $1 unmet basic need at baseline, 68% reported $2 needs, and 39% reported $3 needs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Overall, 42% of WE CARE mothers received at least two referrals at the visit; 21% received at least three referrals.

    “Overall, 42% of WE CARE mothers received $2 referrals at the visit; 21% received $3 referrals.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The most common unmet basic need at baseline was unemployment (57%), followed by housing instability (43%).

    “The most common need was unemployment (57%), followed by housing instability (43%) (Table 2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The Personal Health Questionnaire Depression Scale (PHQ-8) score of >10 has 88% sensitivity and 88% specificity for major depressive episode.

    “This scale consists of 8 questions; a score of .10 has an 88% sensitivity and 88% specificity for major depressive episode.26”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Kroenke, 2009, The PHQ-8 as a measure of current depression in the general population., J Affect Disord source

  • May combine two claims.

    Premisecitation

    Children raised in poverty experience poorer health than children from more advantaged backgrounds and commonly face unmet basic needs such as food security, stable housing, or an adequately heated home.

    “Children raised in poverty experience poorer health than children from more advantaged backgrounds and commonly face unmet basic needs such as food security, stable housing, or an adequately heated home. [3][4][5][6][7][8]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [3] Aber, 1997, The effects of poverty on child health and development., Annu Rev Public Health source
    • cites [4] Duncan, 1997

      Not checked in the free run.

    • cites [5] Brooks-Gunn, 1997, The effects of poverty on children., Future Child source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Overall, follow-up data were obtained for 271 participants (81%).

    “Overall, we obtained follow-up data for 271 participants (81%) (Fig 1).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Addressing the social determinants of child health in the clinical setting is currently more of a moral imperative than an evidence-based practice.

    “Therefore, addressing the social determinants of child health in the clinical setting is currently more of a moral imperative than it is an evidence-based practice.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Initial contact was assessed in both study arms by a brief structured telephone interview performed by a masked research assistant when the infant was 9 months of age.

    “Initial contact was assessed in both study arms by a brief structured telephone interview performed by a masked research assistant when the infant was 9 months of age.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study estimated that each arm would need 168 mothers to detect an absolute difference of 15% in overall enrollment in resources, assuming equal cluster sizes, an intraclass correlation of .01, an enrollment rate of 5% in the control group, statistical power of 80%, a two-tailed alpha of .05, and a 15% loss to follow-up.

    “We estimated that each study arm would need 168 mothers to detect an absolute difference of 15% in the overall enrollment in resources assuming equal cluster sizes, an intraclass correlation of .01,an enrollment rate of 5% in the control group, statistical power of 80%, 2-tailed a of .05,and a 15% loss to follow-up.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Numerous American Academy of Pediatrics policy statements and Bright Futures health supervision guidelines support addressing a child's social needs as part of pediatric practice.

    “Numerous American Academy of Pediatrics policy statements and Bright Futures health supervision guidelines support this view and have been published in an effort to reinforce this practice.[13][14][15][16][17]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [13] Medical Home Initiatives for Children With Special Needs Project Advisory Committee. American Academy of Pediatrics, 2002, The medical home., Pediatrics

      Not checked in the free run.

    • cites [14] Schor, 2003, Family pediatrics: report of the Task Force on the Family., Pediatrics
    • cites [15] American Academy of Pediatrics Council on Community Pediatrics, 2013, . Community pediatrics: navigating the intersection of medicine, public health, and social determinant of children’s health., Pediatrics source

  • May combine two claims.

    Study design and conductreasoning

    Because of a lack of previous studies, the adjusted intraclass correlation coefficient effect was overestimated, which resulted in the ability to detect smaller between-group differences than originally anticipated.

    “Finally, because of a lack of previous studies, we overestimated our adjusted intraclass correlation coefficient effect.This adjustment resulted in our ability to detect smaller between-group differences than we originally anticipated.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    There were no differences in age, gender, clinician type, or years in practice between intervention and control arm clinicians.

    “There were no differences in age, gender, clinician type (pediatrician, nurse practitioner), or years in practice between intervention and control arm clinicians (data not shown).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The study relied on maternal self-report to measure outcomes, which may have introduced social desirability and recall biases.

    “We relied on maternal self-report to measure our outcomes, which may have introduced social desirability and recall biases.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Our previous work found that visit time was marginally increased.

    “our previous work found that visit time was marginally increased.19”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Garg, 2007, Improving the management of family psychosocial problems at low-income children’s well-child care visits: the WE CARE Project., Pediatrics source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Written informed consent was obtained from all participants before enrollment.

    “Written informed consent was obtained from all participants before enrollment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    To assess potential confounding, group differences between sociodemographic variables and basic needs at baseline were examined.

    “To assess potential confounding, we examined group differences between sociodemographic variables and basic needs at baseline.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    The Children's HealthWatch survey questions are internally validated, and a composite measure of cumulative hardships combining food, housing, and energy insecurity has previously been correlated with children's health status, developmental concerns, and a composite child wellness indicator.

    “All Children's HealthWatch questions are internally validated, and a composite Children's HealthWatch measure of cumulative hardships combining food, housing, and energy insecurity has previously been correlated with children's health status, developmental concerns, and a composite child wellness indicator.23”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Frank, 2010, Cumulative hardship and wellness of low-income, young children: multisite surveillance study., Pediatrics source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Community-based resources may be more available in Boston than in other locations.

    “Community-based resources may be more available in Boston than in other locations.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Because no meaningful confounding was found, covariates (race, marital status, and maternal employment) that reduced the intraclass correlation effect were chosen for the regression models.

    “Because we did not find any meaningful confounding, and per Murray and Blistein's 35 suggested method, we chose covariates (race, marital status, and maternal employment) that reduced the intraclass correlation effect for our regression models.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Murray and Blistein's 35

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The primary reviewer for determining enrollment was masked.

    “To determine enrollment, 2 different study team members reviewed the questionnaires, with the primary reviewer being masked.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The WE CARE clinical screening instrument was adapted from a larger family psychosocial screening instrument with test-retest reliability of .92.

    “The WE CARE clinical screening instrument was adapted from a larger family psychosocial screening instrument with test-retest reliability of .92. 19”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Garg, 2007, Improving the management of family psychosocial problems at low-income children’s well-child care visits: the WE CARE Project., Pediatrics source

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    An intention-to-treat approach was used to compare intervention and control groups on study outcomes.

    “An intention-to-treat approach was used to compare intervention and control groups on study outcomes.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisereasoning

    Preterm infants and infants with special health care needs were excluded because such infants are often engaged with other services and could be expected to benefit from WE CARE differently from healthy infants in terms of the outcome measures.

    “We excluded preterm infants and infants with special health care needs because such infants are often engaged with other services (eg, Early Intervention) and could be expected to benefit from WE CARE differently from healthy infants in terms of our outcome measures.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    The study was conducted at community health centers, which may limit its generalizability.

    “The study was conducted at CHCs, which may limit its generalizability.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Silverstein et al demonstrated that a computer-generated clinic-based referral system increased enrollment of low-income children in Head Start.

    “Silverstein et al 41 demonstrated that a computer-generated clinic-based referral system increased enrollment of low-income children in Head Start.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Silverstein, 2004, Effect of a clinic-based referral system to head start: a randomized controlled trial., JAMA source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Effect modification by enrollment wave and maternal depression was tested by entering interaction terms into the regression models.

    “We tested effect modification by enrollment wave and maternal depression by entering interaction terms into the regression models.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Wylie et al demonstrated the impact that a Web-based screening and referral system has on the identification of social needs in adolescents.

    “Wyliet al 42 demonstrated the impact that a Web-based screening and referral system has on the identification of social needs in adolescents.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Wylie, 2012, Assessing and referring adolescents’ health-related social problems: qualitative evaluation of a novel web-based approach., J Telemed Telecare source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The study was approved by the Boston University Medical Center Institutional Review Board and registered on clinicaltrials.gov (NCT01303458).

    “The study was approved by the Boston University Medical Center Institutional Review Board and registered on clinicaltrials.gov(NCT01303458).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    For all outcome measures collected after the index visit, models were adjusted for duration of follow-up time.

    “Additionally, for all outcome measures collected after the index visit, we adjusted the models for duration of follow-up time.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A previous study by our group demonstrated that a similar system can lead to more discussion and referrals for family psychosocial problems by pediatric trainees.

    “A previous study by our group demonstrated that a similar system can lead to more discussion and referrals for family psychosocial problems by pediatric trainees.19”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Garg, 2007, Improving the management of family psychosocial problems at low-income children’s well-child care visits: the WE CARE Project., Pediatrics source

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The results are viewed as more of a proof of principle than evidence of a specific program.

    “We view our results as more of a proof of principle than evidence of a specific program.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    For decades, leaders in pediatrics have argued that addressing a child's social needs falls within the purview of the child health provider.

    “For decades, leaders in the field of pediatrics have argued that addressing a child's social needs falls within the purview of the child health provider.[9][10][11][12]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [9] Haggerty, 1975 source
    • cites [10] Zuckerman, 1995, Preventive pediatrics—new models of providing needed health services., Pediatrics source
    • cites [11] Wood, 2003, Effect of child and family poverty on child health in the United States., Pediatrics source

  • May combine two claims.

    Premisecitation

    The six basic needs were selected for screening because of their high prevalence among urban families, the public availability of community resources designed to address them, and previous research demonstrating their association with negative child outcomes.

    “We decided to screen for these needs because of their high prevalence among urban families, 19,27 the public availability of community resources designed to address them, and previous research demonstrating the association of these needs with negative child outcomes.23,[28][29][30][31][32][33][34]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [19] Garg, 2007, Improving the management of family psychosocial problems at low-income children’s well-child care visits: the WE CARE Project., Pediatrics source
    • cites [27] Garg, 2009, Screening for basic social needs at a medical home for low-income children., Clin Pediatr (Phila) source
    • cites [23] Frank, 2010, Cumulative hardship and wellness of low-income, young children: multisite surveillance study., Pediatrics source
35 of 35

  • The paper relies on this without support.

    There were no systematic biases in receipt of city-wide early childhood and home visitation programs between study groups.

    “However, we are not aware of any systematic biases in receipt of these programs, which probably would have exerted a conservative bias.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Screening practices for social drivers of health, such as food insecurity, are often limited in the clinical setting because of insufficient time, inadequate training, lack of resources, and sensitivity of questions.

    “Screening practices for social drivers of health, such as FI, are often limited in the clinical setting because of insufficient time, inadequate training, lack of resources, and sensitivity of questions [26].”

    From Food Insecurity Screening and Referral Practices of Pediatric Clinicians in Metropolitan Washington, DC (2024) · cites this paper as [26]

    The Discussion (page unavailable) says screening frequency should account for clinic staff capacity and reports that staffing limitations prevented many mothers from receiving surveys at later visits. This supports a resource constraint on screening, but the paper does not identify insufficient time, inadequate training, or question sensitivity as reasons screening is often limited in clinical settings. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Studies of referral-based interventions reported moderate increases in patient food program referrals (SMD = 0.67, 95% CI, 0.36-0.98; SMD = 1.42, 95% CI, 0.76-2.08).

    “Studies of referral-based interventions reported moderate increases in patient food program referrals (SMD = 0.67, 95% CI, 0.36-0.98; SMD = 1.42, 95% CI, 0.76-2.08)”

    From Interventions Addressing Food Insecurity in Health Care Settings: A Systematic Review (2019) · cites this paper as [22]

    Table 3 reports more food referrals in the WE CARE group than in controls (18% versus 6%). The paper reports an adjusted odds ratio, not either cited SMD or its confidence interval, and describes one trial rather than multiple studies. The indexed passage has no page number. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • One study found only modest effects of a waiting room-based intervention on patient enrollment in food-related resources.

    “One study found only modest effects of a waiting room-based intervention on patient enrollment in food-related resources (Table 2). 22”

    From Interventions Addressing Food Insecurity in Health Care Settings: A Systematic Review (2019) · cites this paper as [22]

  • Rates of patients receiving referrals as a result of the intervention ranged from 30% to 75%.

    “Rates of patients receiving referrals as a result of the intervention ranged from 30% to 75% (Table 2). 16,22,27,29,35,40”

    From Interventions Addressing Food Insecurity in Health Care Settings: A Systematic Review (2019) · cites this paper as [22]

  • The evidence supporting the different components of the shared logic model behind social care policies is not yet robust.

    “the evidence supporting the different components of this pathway is not yet robust.”

    From Revising the logic model behind health care's social care investments (2024) · cites this paper as [12]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Household income percentage does not match the counts

    Minor

    The two income categories contain 332 mothers in total, so 260 mothers represent 78.3%, not 79%. Using all 336 enrolled mothers would yield 77.4%, also not 79%.

    Reported 79 · recomputed 77.380952

  • Multiracial category percentage is understated

    Minor

    Sixteen of 336 mothers is 4.76%, which rounds to 5%, not the reported 4%. Excluding mothers with unknown race would make the percentage higher, not lower.

    Reported 4 · recomputed 4.761905

  • Citation number does not identify the named authors

    Minor

    The methods text cites Murray and Blistein as reference 35, but their work is listed as reference 34.

3 of 3

Cites

Flagged first, then by citations

2 of the 55 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Shonkoff, 2000, From Neurons to Neighborhoods

Cited by

Sorted by citations

Related

Authors
Garg, A., Toy, S., Tripodis, Y., Silverstein, M., & Freeman, E.
Affiliations
  • Boston University (US)
  • Northeastern University (US)
ORCID
Venue
Pediatrics
Publisher
American Academy of Pediatrics (AAP)
Published
2015-02-01
Volume
135
Issue
2
Pages
e296-e304
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.2014-2888
PMC
PMC4306802
OpenAlex
W2033448635
Cited by
643
References
55
Citations by year
2026: 40 · 2025: 49 · 2024: 70 · 2023: 82 · 2022: 84 · 2021: 76 · 2020: 71 · 2019: 52 · 2018: 50 · 2017: 27 · 2016: 30 · 2015: 11
FWCI
71.73
Type
journal article
Language
en
Open access
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • National Institute of Child Health and Human Development
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R00HD056160)
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 › Public Health and Social Inequalities
Keywords
social determinants of health, well-child care, unmet basic needs, community resource referral, community health centers, food security, housing, child care, employment, homelessness, mothers of infants
MeSH terms
Adult, Child, Child Welfare, Child, Preschool, Community Health Centers, Female, Follow-Up Studies, Humans, Infant, Male, Mass Screening, Primary Health Care, Surveys and Questionnaires, Referral and Consultation, Social Work, United States, Cluster Analysis, Community Networks, Needs Assessment, Vulnerable Populations, Social Determinants of Health

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

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