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

In the paper

“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”

What the sources say

• ?Not checked — no full text of the sourcecites [23] Frank, 2010, Cumulative hardship and wellness of low-income, young children: multisite surveillance study., Pediatrics source
• Partly supported

  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)

  cites [25] Cook, 2006, Child food insecurity increases risks posed by household food insecurity to young children’s health., J Nutr sourceExperimental — accuracy not yet measured

In the paper

“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”

What the sources say

• Supported

  The Abstract says social factors are at the root of many health inequalities. Panel 2, “The solid facts,” states directly that the circumstances in which people live and work matter for both communicable and non-communicable disease. (LLM, conf=0.93)

  cites [1] Marmot, 2006 source

In the paper

“More than 90% of subjects reported $1 unmet basic need at baseline, 68% reported $2 needs, and 39% reported $3 needs.”

In the paper

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

In the paper

“The most common need was unemployment (57%), followed by housing instability (43%) (Table 2).”

In the paper

“This scale consists of 8 questions; a score of .10 has an 88% sensitivity and 88% specificity for major depressive episode.26”

What the sources say

• ?Not checked — no full text of the sourcecites [26] Kroenke, 2009, The PHQ-8 as a measure of current depression in the general population., J Affect Disord source

In the paper

“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]”

What the sources say

• ?Not checked — no full text of the sourcecites [3] Aber, 1997, The effects of poverty on child health and development., Annu Rev Public Health source
• Not checked yetcites [4] Duncan, 1997
• ?Not checked — no full text of the sourcecites [5] Brooks-Gunn, 1997, The effects of poverty on children., Future Child source

In the paper

“Overall, we obtained follow-up data for 271 participants (81%) (Fig 1).”

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

In the paper

“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]”

What the sources say

• Not checked yetcites [13] Medical Home Initiatives for Children With Special Needs Project Advisory Committee. American Academy of Pediatrics, 2002, The medical home., Pediatrics
• ?Not checked — no full text of the sourcecites [14] Schor, 2003, Family pediatrics: report of the Task Force on the Family., Pediatrics
• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

In the paper

“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).”

In the paper

“We relied on maternal self-report to measure our outcomes, which may have introduced social desirability and recall biases.”

In the paper

“our previous work found that visit time was marginally increased.19”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“Written informed consent was obtained from all participants before enrollment.”

In the paper

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

In the paper

“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”

What the sources say

• ?Not checked — no full text of the sourcecites [23] Frank, 2010, Cumulative hardship and wellness of low-income, young children: multisite surveillance study., Pediatrics source

In the paper

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

In the paper

“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.”

What the sources say

• ?Not matched

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

  cites Murray and Blistein's 35

In the paper

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

In the paper

“The WE CARE clinical screening instrument was adapted from a larger family psychosocial screening instrument with test-retest reliability of .92. 19”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

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

In the paper

“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.”

In the paper

“The study was conducted at CHCs, which may limit its generalizability.”

In the paper

“Silverstein et al 41 demonstrated that a computer-generated clinic-based referral system increased enrollment of low-income children in Head Start.”

What the sources say

• ?Not checked — no full text of the sourcecites [41] Silverstein, 2004, Effect of a clinic-based referral system to head start: a randomized controlled trial., JAMA source

In the paper

“We tested effect modification by enrollment wave and maternal depression by entering interaction terms into the regression models.”

In the paper

“Wyliet al 42 demonstrated the impact that a Web-based screening and referral system has on the identification of social needs in adolescents.”

What the sources say

• ?Not checked — no full text of the sourcecites [42] Wylie, 2012, Assessing and referring adolescents’ health-related social problems: qualitative evaluation of a novel web-based approach., J Telemed Telecare source

In the paper

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

In the paper

“Additionally, for all outcome measures collected after the index visit, we adjusted the models for duration of follow-up time.”

In the paper

“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”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“We view our results as more of a proof of principle than evidence of a specific program.”

In the paper

“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]”

What the sources say

• ?Not checked — no full text of the sourcecites [9] Haggerty, 1975 source
• ?Not checked — no full text of the sourcecites [10] Zuckerman, 1995, Preventive pediatrics—new models of providing needed health services., Pediatrics source
• ?Not checked — no full text of the sourcecites [11] Wood, 2003, Effect of child and family poverty on child health in the United States., Pediatrics source

In the paper

“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]”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [27] Garg, 2009, Screening for basic social needs at a medical home for low-income children., Clin Pediatr (Phila) source
• ?Not checked — no full text of the sourcecites [23] Frank, 2010, Cumulative hardship and wellness of low-income, young children: multisite surveillance study., Pediatrics source