Socially Equitable Care by Understanding Resource Engagement (SECURE): Leveraging Research to Ensure Equity
Statement of Problem
Economic hardships can significantly impede a child’s development, overall health and well-being, and the ability to succeed in school and in life. The current economic recession and racial disparities underscored by COVID-19 have magnified this impact on children and hastened the already rapid growth of screening protocols for social risk factors—such as food and housing insecurity, financial strain and unsafe environments—within pediatric health care.
Although screening is generally the first step in social risk interventions, this may lead to inequality in the distribution and utilization of social resources through three major mechanisms: 1) discordance between screening results and desire for services; 2) discomfort with screening and fear of negative repercussions; 3) racial biases in screening. Eliminating screening processes may help to reduce inequality in the distribution of resources, and in turn, can decrease disparities in health and behavioral outcomes for children when families receive and engage with social resources.
Utilizing a mixed-method approach, our study will answer the major research question: does offering social resources without preceding social risk screening improve acceptance, perception and engagement with social resources among families with children? Furthermore, by introducing resource mapping technology as the method of resource referral, this study will provide insight regarding its effectiveness as a social needs assistance strategy.
Our study will involve more than 2,000 parents or caregivers of patients ages 0-21 years receiving care at three Children’s Hospital of Philadelphia Primary Care practices. We will offer social resources through an electronic resource map and personalized resource navigation to this population, with half randomized to undergo social risk screening prior to receiving those resources. Among the screening group, we will use an adapted version of the evidence-based WE CARE screening tool, which assesses need in the five domains most frequently requested by our patient population: housing, transportation, child care, food security, and household heat and electricity.
First, we will conduct a multi-site randomized controlled trial comparing caregiver acceptance of resources, defined by use of a searchable electronic resource map, introduced with or without a preceding standardized social risk screening tool. We will then conduct a pre-post analysis of the impact of screening on resource engagement and utilization and resulting change in social risk. Finally, we will explore, using qualitative methods, how caregiver comfort level and interest in services is affected by social risk screening.
While addressing social risk may be considered a moral imperative, this contribution will move the work toward evidence-based practice by carefully examining the impact of screening. We hope that the findings of this study will be directly applied to institutional and regional interventions that address social risk, and will inform adjustments to current policies and practices, including potential de-implementation of social risk screening.
Children's Hospital of Philadelphia, PolicyLab. Evaluating the Impact of Social Risk Screening on Uptake of Social Assistance: Leveraging Research to Ensure Equity [online]. Available at: http://www.policylab.chop.edu. [Accessed: plug in date accessed here].