Language and demographic disparities in social needs and referral preferences in the pediatric ED

Objective: To examine disparities in unmet social needs (USNs) and caregiver interest in community resource center (CRC) referrals in the pediatric emergency department (PED), focusing on language preference, insurance, and race/ethnicity, and to explore predictors of referral interest. 

Methods: This observational study utilized administrative data from the real-world prospective effectiveness parent study [5R01NR019944-04]. English- and Spanish-speaking caregivers of pediatric patients (<18 years) presenting to a free-standing, quaternary care, level 1 trauma center PED were recruited using convenience sampling through a research assistant program. Caregivers completed a 10-item social needs screener (p-SINCERE), followed by an opt-in referral opportunity to 211Utah, and child-specific demographic questions. Outcomes included USN prevalence (≥1 reported need) and caregiver interest in CRC referral. Descriptive statistics summarized characteristics, and multivariable logistic regression identified predictors of referral interest. 

Results: Of 18,319 caregivers approached, 16,909 (92.3%) completed the screener. USN prevalence was 47.2% among English-speaking, 78.3% among Spanish-speaking, and 53% among other-language caregivers. Overall, 15.4% expressed interest in CRC referral, including 9.8% of English-speaking, 53.3% Spanish-speaking, and 31.3% of other-language caregivers. Multivariable analysis revealed that Spanish language preference, public or no insurance, Hispanic ethnicity, and non-White racial backgrounds were independently associated with greater interest in referral. A "voltage drop" was observed between USN disclosure and referral interest. 

Conclusions: Disparities in USNs and referral interest vary by language, insurance, and race/ethnicity. The gap between need identification and interest in connecting to resources highlights the need for linguistically and culturally responsive interventions and system-level strategies to advance health equity in the PED.