Neonatal Embedded Social Support Team (NEST): A novel framework for social screening in the nursery

Background: The American Academy of Pediatrics recommends universal screening for social determinants of health (SDOH) in infants. The current standard of care at Zuckerberg San Francisco Hospital (ZSFG), a county safety net hospital with 67% Latine population, is for birthing parents to be screened for SDOH needs upon admission by the Labor & Delivery (L&D) nursing team. 

Objective: This project describes a first-of-its-kind framework for social screening in NICU/Nursery, embedding trained community health workers alongside the pediatrics medical team in screening for SDOH. This new framework enhances the ease of identification of SDOH needs to efficiently connect families to resources, while simultaneously allowing the pediatrics medical team to fully focus on the key medical concerns of the infants. 

Methods: We conducted qualitative, semi-structured interviews with families, healthcare professionals, and social workers, to identify barriers to effective SDOH screening. The medical team identified time constraints and insufficient knowledge and training on follow-up procedures to connect families with resources as major obstacles. To address these barriers, we implemented a pilot protocol from 2/13/24- 7/24/24 in the NICU/Nursery, diffusing the responsibility for SDOHscreening by incorporating community health workers on designated days to assist the pediatric physician team. 

Results & Conclusion: During the pilot, the percentage of birthing parents who had a positive SDOHneeds screen (food, housing, transportation, utilities) by the L&D nursing team was 9.95% (139/1396). In contrast, when screened by the pediatrics NEST team, 26.003% (363/1396) of patients screened positive for needs, indicating that the enhanced screening team detected over double the number of positive screens for social needs. This research compellingly underscores the need for more community health workers to be embedded within inpatient pediatric units.

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