A Mixed-Method Evaluation of the Impact of Social Risk Screening on Uptake of Social Assistance

Children are disproportionately affected by the rise in poverty rates in the United States. Economic hardships can compromise child development, overall health, and the ability to succeed in school and in life. The current economic recession and racial disparities underscored by COVID19 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. However, it remains unclear what effect standardized screening has on family perception of and engagement with resources. Current implementation momentum for screening protocols is outpacing research, and is raising concern among patient advocates for unintended harm-alienating families for fear of stigma or worse, and overpromising services that may not exist. Through a rigorous mixed-method approach, the proposed study will explore the impact of screening on acceptance, perception, and engagement with social resources among families with children. Furthermore, by leveraging the new technology of resource mapping as the method of resource referral, this study will provide insight regarding its effectiveness as a social needs assistance strategy. The knowledge gained will provide guidance for policymakers and other healthcare systems on how to integrate social risk interventions into healthcare delivery in order to maximize the benefit to children and families.

Study Overview

• Status: Completed
• Conditions: Social Determinants of Health; Low-income Populations
• Intervention / Treatment: Behavioral: Social Risk Screening Tool; Other: Electronic Resource Map; Behavioral: Resource Menu

• Study Type: Interventional
• Enrollment (Actual): 3949
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19146
      • Children's Hospital of Philadelphia

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 100 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Caregivers presenting with a child to the pediatric clinical setting
• Child age 0-25

Exclusion Criteria:

• Engaged in complex care management services
• Child in critical condition
• Presenting to clinical setting specifically for social work intervention

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Social Risk Screening + Resource Map; Participants randomized to the experimental arm will receive a social risk assessment tool followed by an electronic resource map	Behavioral: Social Risk Screening Tool; Investigators will use an adapted version of the evidence-based WE CARE screening tool, which assesses need in the 5 domains most frequently requested by our patient population: housing, transportation, child care, food security, and household heat and electricity. This tool was selected as it is evidence-based, takes fewer than 5 minutes to complete, is written at a 3rd grade reading level, and allows for differentiation between social risk and caregiver desire for assistance, as well as areas of "emergency" need.; Other: Electronic Resource Map; All participants will receive access to an electronic, geographically searchable resource map hosted on Aunt Bertha
Active Comparator: Resource Map; Participants randomized to the active comparator group will receive only an electronic resource map	Other: Electronic Resource Map; All participants will receive access to an electronic, geographically searchable resource map hosted on Aunt Bertha
Experimental: Resource Menu + Resource Map; Participants randomized to this experimental arm will receive a social resource menu tool followed by an electronic resource map.	Behavioral: Resource Menu; Participants randomized to this experimental arm will receive a social resource menu tool, which assess desire for social resources.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Resource Uptake By Search	total number of searches	30 days
Resource Uptake By Domain	number of searches by domain	30 days
Resource Engagement By Time	time spent on site	30 days
Resource Engagement By Saves	number of resources saved	30 days
Resource Engagement By Domain	number of resources saved by domain	30 days
Resource Utilization	rates of resource utilization	30 days
Resource Impact	perceived impact of resource use on social need measured by using a modified version of the WE CARE screening tool	30 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Perceived impact of screening on resource acceptance	Qualitative semi-structured interviews	up to 45 days
Perceived impact of screening on resource perception	Qualitative semi-structured interviews	up to 45 days

Collaborators and Investigators

• Sponsor: Children's Hospital of Philadelphia
• Investigators: Principal Investigator: Danielle Cullen, MD MPH MSHP, Children's Hospital of Philadelphia

Study record dates

Study Major Dates

• Study Start (Actual): April 19, 2022
• Primary Completion (Actual): September 22, 2023
• Study Completion (Actual): September 22, 2023

Study Registration Dates

• First Submitted: September 30, 2021
• First Submitted That Met QC Criteria: February 10, 2022
• First Posted (Actual): February 22, 2022

Study Record Updates

• Last Update Posted (Estimated): November 27, 2024
• Last Update Submitted That Met QC Criteria: November 25, 2024
• Last Verified: November 1, 2024

More Information

Terms related to this study

• Other Study ID Numbers: 21-018785

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No