Addressing families' unmet social needs within pediatric primary care: The Health Leads model

The Institute of Medicine has stated that “practicing in the context of family and community” is a fundamental tenet of primary care. This is particularly important in pediatrics, where social determinants of health powerfully shape children’s well-being. Prior studies have demonstrated the impact that family psychosocial issues (e.g., poverty, food insecurity, and housing instability) can have on children’s health and development. Pediatric professional guidelines including the Bright Futures health supervision guidelines recommend that primary care providers address the social milieu of their patients; however, few routinely do so. Provider barriers include lack of time, professional training, and knowledge of community resources.

Within the medical home, innovative multidisciplinary team-based approaches are needed to assist providers with identifying social problems and referring families with unmet needs to available community-based resources, particularly for low-income populations where basic material needs are common. Nonmedical team members have traditionally included social workers, community outreach workers, patient navigators, and lawyers. This report describes a new management approach to addressing families’ unmet social needs within pediatric primary care, namely, using volunteer undergraduate students to assist providers with their patients’ social needs.

Health Leads (HL; formerly Project HEALTH) is a nonprofit organization, founded in 1996 at Boston Medical Center (formerly Boston City Hospital), that places undergraduate students in urban clinics to assist impoverished families with their social needs. Currently, HL operates 21 help desks at urban medical homes across the United States; approximately 800 students from 12 universities serve 9000 families annually. We describe the impact of the HL model on families’ receipt of community-based resources at an urban pediatric clinic. This integrated care model includes (a) parents completing a brief previsit screening survey for social issues (e.g., food, housing, employment, etc) at well-child care visits, (b) providers referring to the HL desk located in the clinic, and (c) HL students connecting families to community-based resources through in-person meetings and telephone follow-up. HL students then update referring providers about outcomes.