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
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
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DOI：
10.1001/jamanetworkopen.2020.0701
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发表时间：
2020-03-10
影响因子：
13.8
通讯作者：
Hessler, Danielle
中科院分区：
文献类型：
--
作者：
Gottlieb, Laura M.;Adler, Nancy E.;Hessler, Danielle
社会和经济环境塑造儿童的短期和长期健康。努力解决背景风险因素越来越多地纳入儿科医疗保健。目的比较两种社会风险相关干预措施的效果。设计、设置和参与者这项随机临床试验包括从一家大型城市安全网医院的儿科紧急护理诊所招募的讲英语和/或西班牙语的儿童配对。研究招募、入组和随访于2016年7月18日至2019年3月8日进行。数据分析于2019年1月1日至2020年1月20日进行。干预措施标准化的社会风险评估后，照顾者被随机分配到接收有关政府和社区社会服务资源的书面信息或类似的书面信息加上面对面的援助和后续关注的服务访问。主要结果和测量在登记后6个月，看护者报告的社会风险因素和儿童健康的数量。结果在611对被试中，302对被试被随机分配到书面资源组，309对被试被随机分配到书面资源+面对面帮助组。儿童的平均（SD）年龄为6.1（5.0）岁; 483名儿童（79.1%）为西班牙裔; 315名儿童（51.6%）为女孩。干预措施的效果在两组之间没有显著差异。在事后二次分析中，两组报告的社会风险数量从基线到6个月随访均有所下降：仅接受书面资源的护理人员在随访时报告的风险平均（SE）减少1.28（0.19），而接受书面资源加亲自协助的护理人员在随访时报告的风险减少1.74（0.21）（均P <0.001）。在两组中，从基线到随访，儿童健康都有小但统计学上显著的改善（平均[SE]变化：书面资源，0.37 [0.07];书面资源加亲自帮助，0.24 [0.07];两者P <0.001）。结论和相关性这项随机临床试验比较了两种方法来解决儿科紧急护理环境中的社会风险，发现在护理点提供书面资源与不提供面对面纵向导航服务的社会风险和儿童及护理人员健康影响无统计学显著差异。两组的看护者在干预后6个月报告了更少的社会风险和改善的儿童和看护者健康。这些发现加深了对社会风险相关干预措施有效剂量的理解。
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.