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

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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.