Effects of In-Person Assistance vs Personalized Written Resources About Social Services on Household Social Risks and Child and Caregiver Health: A Randomized Clinical Trial

Laura M Gottlieb, Nancy E Adler, Holly Wing, Denisse Velazquez, Victoria Keeton, Abigail Romero, Maricarmen Hernandez, Andrea Munoz Vera, Elizabeth Urrutia Caceres, Catherine Arevalo, Philip Herrera, Mara Bernal Suarez, Danielle Hessler, Laura M Gottlieb, Nancy E Adler, Holly Wing, Denisse Velazquez, Victoria Keeton, Abigail Romero, Maricarmen Hernandez, Andrea Munoz Vera, Elizabeth Urrutia Caceres, Catherine Arevalo, Philip Herrera, Mara Bernal Suarez, Danielle Hessler

Abstract

Importance: Social and economic contexts shape children's short- and long-term health. Efforts to address contextual risk factors are increasingly incorporated into pediatric health care.

Objective: To compare the effectiveness of 2 social risk-related interventions.

Design, setting, and participants: This randomized clinical trial included English- and/or Spanish-speaking caregiver-child dyads recruited from a pediatric urgent care clinic nested in a large, urban, safety-net hospital. Study recruitment, enrollment, and follow-up were conducted from July 18, 2016, to March 8, 2019. Data analysis was conducted from January 1, 2019, to January 20, 2020.

Interventions: Following standardized social risk assessment, caregivers were randomly assigned to receive either written information regarding relevant government and community social services resources or comparable written information plus in-person assistance and follow-up focused on service access.

Main outcomes and measures: Caregiver-reported number of social risk factors and child health 6 months after enrollment.

Results: Among 611 caregiver-child dyads enrolled in the study, 302 dyads were randomized to the written resources group and 309 dyads were randomized to the written resources plus in-person assistance group. The mean (SD) age of children was 6.1 (5.0) years; 483 children (79.1%) were Hispanic; and 315 children (51.6%) were girls. There were no significant differences between groups in the effects of the interventions. In post hoc secondary analyses, the number of reported social risks decreased from baseline to 6-month follow-up in both groups: caregivers who received written resources alone reported a mean (SE) of 1.28 (0.19) fewer risks at follow-up, while those receiving written resources plus in-person assistance reported 1.74 (0.21) fewer risks at follow-up (both P < .001). In both groups, there were small but statistically significant improvements from baseline to follow-up in child health (mean [SE] change: written resources, 0.37 [0.07]; written resources plus in-person assistance, 0.24 [0.07]; both P < .001).

Conclusions and relevance: This randomized clinical trial compared 2 approaches to addressing social risks in a pediatric urgent care setting and found no statistically significant differences in the social risk and child and caregiver health effects of providing written resources at the point of care with vs without in-person longitudinal navigation services. Caregivers in both groups reported fewer social risks and improved child and caregiver health 6 months after the intervention. These findings deepen understanding of effective doses of social risk-related interventions.

Trial registration: ClinicalTrials.gov Identifier: NCT02746393.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Gottlieb reported receiving grants from the Agency for Healthcare Research and Quality, Episcopal Health Foundation, Robert Wood Johnson Foundation, Commonwealth Fund, and Kaiser Permanente outside the submitted work. No other disclosures were reported.

Figures

Figure.. CONSORT Flow Diagram
Figure.. CONSORT Flow Diagram

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