Effects of Social Needs Screening and In-Person Service Navigation on Child Health A Randomized Clinical Trial
Effects of Social Needs Screening and In-Person Service Navigation on Child Health A Randomized Clinical Trial
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DOI：
10.1001/jamapediatrics.2016.2521
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发表时间：
2016-11-01
期刊：
影响因子：
26.1
通讯作者：
Adler, Nancy E.
中科院分区：
文献类型：
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作者：
Gottlieb, Laura M.;Hessler, Danielle;Adler, Nancy E.
重要性健康的社会决定因素塑造儿童的直接健康和他们一生的疾病风险。越来越多的儿科医疗保健组织正在干预，以解决家庭社会逆境。然而，很少有证据是相关interventions.Objective的有效性，以评估社会需求筛选和在人的资源导航服务对社会需求和儿童health.DESIGN，设置，和参与者的影响患者被随机干预或积极控制条件的一周中的一天。入组后4个月观察的主要结局包括照顾者对社会需求和儿童健康状况的报告。招募发生在2013年10月13日至2015年8月27日之间，在2家安全网医院的儿科初级和紧急护理诊所进行。参与者是讲英语或讲西班牙语的照顾者陪同未成年儿童非急性医疗访问。干预标准化筛选后，照顾者要么收到有关社区服务的书面信息，（主动控制）或接受亲自帮助以获得服务，并在需要时通过后续电话寻求进一步帮助（导航干预）主要结果和指标4个月后报告的社会需求和照顾者对儿童整体健康评估的变化。研究中，2个研究中心平均分配，31.6%（n = 572）入组初级保健诊所，68.4%（n = 1237）入组紧急护理环境。儿童主要为西班牙裔白色个体（50.9% [n = 921]）和非西班牙裔黑人个体（26.2%[n = 473]），平均（SD）年龄为5.1（4.8）岁; 50.5%（n = 913）为女性。基线时报告的社会需求数量在14个可能项目中从0到11个不等，平均值（SD）为2.7（2.2）。在入组后4个月，干预组报告的社会需求数量比对照组报告的减少更多，平均（SE）变化为-0.39（0.13）vs 0.22（0.13）（P
IMPORTANCE Social determinants of health shape both children's immediate health and their lifetime risk for disease. Increasingly, pediatric health care organizations are intervening to address family social adversity. However, little evidence is available on the effectiveness of related interventions.OBJECTIVE To evaluate the effects of social needs screening and in-person resource navigation services on social needs and child health.DESIGN, SETTING, AND PARTICIPANTS Patients were randomized to intervention or active control conditions by the day of the week. Primary outcomes observed at 4 months after enrollment included caregivers' reports of social needs and child health status. Recruitment occurred between October 13, 2013, and August 27, 2015, in pediatric primary and urgent care clinics in 2 safety-net hospitals. Participants were English-speaking or Spanish-speaking caregivers accompanying minor children to nonacute medical visits.INTERVENTIONS After standardized screening, caregivers either received written information on relevant community services (active control) or received in-person help to access services with follow-up telephone calls for further assistance if needed (navigation intervention).MAIN OUTCOMES AND MEASURES Change in reported social needs and in caregiver assessment of child's overall health reported 4 months later.RESULTS Among 1809 patients enrolled in the study, evenly split between the 2 sites, 31.6% (n = 572) were enrolled in a primary care clinic and 68.4%(n = 1237) were enrolled in an urgent care setting. The children were primarily Hispanic white individuals (50.9% [n = 921]) and non-Hispanic black individuals (26.2%[n = 473]) and had a mean (SD) age of 5.1 (4.8) years; 50.5%(n = 913) were female. The reported number of social needs at baseline ranged from 0 to 11 of 14 total possible items, with a mean (SD) of 2.7 (2.2). At 4 months after enrollment, the number of social needs reported by the intervention arm decreased more than that reported by the control arm, with a mean (SE) change of -0.39 (0.13) vs 0.22 (0.13) (P