Addressing Low-Income Families' Basic Social Needs at Pediatric Visits

描述（由申请人提供）：低收入家庭往往难以满足基本的社会需求，如食物、住房、就业和儿童保育。在这种环境中长大的儿童健康和发育不良的风险更大。初级保健医学的一个基本原则是医生“在家庭和社区的背景下执业”。然而，很少有儿科医生会定期解决家庭的基本社会需求。候选人的长期职业目标是通过基于理论和研究的干预措施，在儿科初级保健的背景下解决家庭的基本社会需求，减少健康差距。他最近完成的奖学金研究——在巴尔的摩的一个城市儿科初级保健诊所进行的一项随机对照试验——证明了一项协议对父母对家庭社会心理问题的自我认同、提供者对家庭需求的讨论以及将家庭转介到社区资源以解决这些需求的积极影响。辅导阶段有三个目标：(1)建立与基于初级保健的战略相关的观察和干预研究技能，通过解决家庭心理社会需求来促进儿童的发展；(2)获得卫生政策技能；(3)获得发展社区社会机构与儿科初级保健之间合作的经验。在独立阶段，候选人将开发并实验测试基于初级保健的基本需求监测（BNS）协议对家庭、父母和儿童结果的影响。BNS协议源自他的奖学金项目协议；它还纳入了发展监测和慢性护理模式的概念，以加强该模式并提高初级保健站点的实施保真度。独立研究的目的是：(1)证明在儿科实践中实施BNS方案的可行性；(2)评估其对低收入家庭使用社区资源、基本社会需求、父母幸福感和儿童卫生保健利用的影响；(3)探讨协议对社区资源使用、基本需求、父母幸福感和儿童医疗保健利用影响的中介和调节作用。近40%的美国儿童生活在低收入家庭。该项目将进一步发挥初级保健在满足家庭基本社会需求方面的作用，作为减少健康差距的一项战略（2010年《健康人》的主要目标），并确保低收入儿童“有机会充分发挥其潜力，过上健康和富有成效的生活”（联合国儿童健康与发展中心的一项既定使命）。

DESCRIPTION (provided by applicant): Low-income families often struggle to meet basic social needs such as food, housing, employment, and childcare. Children growing up in such an environment are at increased risk for poor health and development. A fundamental tenet of primary care medicine is for physicians to "practice in the context of family and community". However, few pediatric providers routinely address families' basic social needs. The candidate's long-term career goal is to reduce health disparities through theory- and research-based interventions addressing families' basic social needs in the context of pediatric primary care. His recently completed fellowship research ~ a randomized controlled trial at an urban pediatric primary care clinic in Baltimore ~ demonstrated the positive impact of a protocol for parental self-identification of family psychosocial problems, providers' discussion of family needs, and referral of families to community resources to address these needs. The mentored phase has three goals: (1) to build observational and intervention research skills pertinent to primary care-based strategies to promote child outcomes by addressing family psychosocial needs; (2) to acquire health policy skills; and (3) to gain experience developing collaborations between community social agencies and pediatric primary care. In the independent phase, the candidate will develop and test experimentally the impact of a primary care-based Basic Needs Surveillance (BNS) protocol on family, parent, and child outcomes. The BNS protocol is derived from his fellowship project's protocol; it also incorporates concepts from developmental surveillance and the Chronic Care Model to strengthen the model and enhance implementation fidelity across primary care sites. The aims for the independent study are to: (1) demonstrate the feasibility of implementing the BNS protocol in pediatric practice; (2) assess its effects on low-income families' use of community resources, basic social needs, parental well-being, and pediatric health care utilization; and (3) explore mediation and moderation of the protocol's impact on use of community resources, basic needs, parental well-being, and pediatric health care utilization. Nearly 40 percent of children in the US live in low-income families. This project will further develop primary care's role in addressing families' basic social needs as a strategy to reduce health disparities - a main goal of Healthy People 2010 - and to ensure that low-income children have "the chance to achieve their full potential for healthy and productive lives" - a stated mission of the NICHD.