Participation in clinic-based referral and navigation services among families with social needs

IMPORTANCE: Social determinants of health (SDOH) are associated with health outcomes. Thus, providing referrals for unmet social needs within clinical settings may improve the health of children. 

OBJECTIVE: To examine the prevalence and demographic characteristics of pediatric families with unmet social needs and their association with families accepting help from a pediatric clinical practice. 

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined data from a comprehensive SDOH screening and referral program at a large academic pediatric practice in the US. Participants were caregivers of patients younger than 17 years and indicated at least 1 social need. Data were collected from April 16, 2018, through September 29, 2019, and analyzed from November 18, 2019, through December 17, 2019. The data review was finalized December 20, 2023. EXPOSURE: Screening for SDOH in primary care. 

MAIN OUTCOME AND MEASURES: The main outcome was interest in assistance among patient families with at least 1 social need. Factor analyses categorized social needs as basic needs, stress, challenges to economic mobility, and marginalization. χ2 Tests and multivariable Poisson regression were used to examine the associations between patient characteristics and caregiver interest in assistance. 

RESULTS: There were 758 caregivers (median [IQR] age, 34 [29-40] years; 614 mothers [81.0%]) reporting at least 1 unmet social need, such as food or utility insecurity or unemployment. The median age of children was 23 months (IQR, 4-70 months), and 163 (21.5%)were of Asian, Pacific Islander, or Native Hawaiian ; 213 (28.1%) of Black; 156 (20.6%) of Latino or Hispanic; 37 (4.9%) of White ; and 122 (16.1%) of other race and ethnicity. A total of 315 caregivers (41.6%) were not interested in assistance. Families with basic needs (adjusted prevalence ratio [PR], 5.56; 95% CI, 3.33-10.00), stress (adjusted PR, 1.75; 95% CI, 1.43-2.17), challenges to economic mobility (adjusted PR, 2.17; 95% CI, 1.67-2.86), or marginalization (adjusted PR, 1.41; 95% CI, 1.15-1.72) were more likely to be interested in assistance. Additionally, Black race (adjusted PR, 1.23; 95% CI, 1.01-1.49), other race and ethnicity (adjusted PR, 1.22; 95% CI, 1.01-1.47), and inadequate social support (adjusted PR, 1.85; 95% CI, 1.32-2.63) were associated with acceptance of referral services. 

CONCLUSIONS AND RELEVANCE: These findings suggest that the implementation of referral programs may help to achieve health equity, especially among marginalized populations, and improve the referral process for families who have social needs but are not interested in assistance.