Implementing a Social Determinants of Health Screening and Referral Care Model in the Neonatal Intensive Care Unit

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PROJECT SUMMARY Social determinants of health (SDOH)—the conditions in which people are born, grow, work, live, and age— are key drivers of health disparities. The American Academy of Pediatrics, the National Academy of Medicine, and payers such as the Centers for Medicaid and Medicare Services recommend integrating screening for adverse SDOH and generating referrals to social services within the healthcare delivery system as a central way to promote patient and population health. While many pediatric outpatient practices are now implementing SDOH screening, little attention has been paid to the inpatient setting, representing a missed opportunity to advance health equity. Overall, ten percent of U.S. infants are born preterm and they are disproportionately born to low-income and minority mothers. Up to a quarter of families with preterm infants have unmet basic needs, such as housing or job insecurity, which represent adverse SDOH. Preterm infants are especially vulnerable to early-life programming by the social conditions that they grow up in, with sustained impacts on function across multiple organ systems. Unfortunately, efforts to implement effective interventions that address unmet basic needs in the neonatal intensive care unit (NICU) where preterm infants are hospitalized after birth for weeks to months are lacking. The goal of this proposal is to translate an established model of SDOH screening and referral from the outpatient pediatric setting to the NICU, thereby maximizing the potential to offset effects of adverse SDOH on vulnerable mother-preterm infant dyads. Our study team has previously developed and tested the low-touch SDOH screening and referral intervention called “WE CARE” in the outpatient pediatric setting and demonstrated its effectiveness on increasing receipt of community resources. We now propose a hybrid effectiveness-implementation cluster RCT in 8 U.S. safety-net NICUs (4 WE CARE NICUs and 4 control NICUs), using the Proctor Conceptual Model of Implementation Research. We will implement WE CARE into 4 NICUs and longitudinally follow a cohort of 576 mother-preterm infant dyads (288 per study arm) for 12 months after NICU discharge. In Aim 1, we will examine the implementation of WE CARE into the NICU, assessing its appropriateness, feasibility, penetration, equity, and sustainability. In Aim 2, we will examine the effectiveness and equity of WE CARE in the NICU setting on parental receipt of community resources for unmet basic needs 3-months post-NICU discharge. Finally, in Aim 3, we will explore the effect of WE CARE on maternal mental health and preterm infant health and development. The proposed low-intensity, scalable WE CARE intervention has tremendous potential to shift the paradigm of systematic social needs screening and referral from the outpatient to inpatient healthcare delivery system and address adverse SDOH at the earliest stages of life in a highly vulnerable pediatric population, with the potential to improve children’s health and developmental trajectories along with maternal mental health and well-being.