A health system-wide approach to addressing unmet social needs among children with asthma

It is well known that unhealthy housing, financial hardships, and lack of access to resources contribute to higher rates of asthma morbidity and health disparities. Despite extensive literature demonstrating that social factors drive health inequities in pediatric asthma, and although general social risk screening has been used in hospital settings to identify and address health-related social risks, asthma-specific screening models have not been well described. Furthermore, whereas social risk screening involves the identification of specific adverse conditions associated with poor health outcomes, social needs screening shifts the focus to patient and family preferences and priorities, which may facilitate more efficient, effective, and equitable provision of resources. Using the Exploration, Preparation, Implementation, and Sustainment framework, we describe the process of implementing a health system-wide, asthma-specific social needs checklist. The community-based asthma program at our institution had previously implemented social needs screening in 2018, and we report on the process of expanding its use to multiple settings at a single urban pediatric medical center. We evaluate the feasibility, acceptability, and sustainability of implementation in these new settings and describe the social needs of families of children with asthma at our institution. Screening was broadly acceptable to families. Feasibility and sustainability varied by site and was more successful at sites with leadership buy-in and dedicated staffing. Overall, screening revealed a high burden of unmet social needs. Future work includes addressing barriers to screening and studying the impact of a system-wide, longitudinal approach on patient experience and outcomes.