Pediatric social risk screening: Leveraging research to ensure equity

The effects of poverty on child health have been exacerbated by the COVID19 pandemic and concurrent economic recession, magnifying the urgency for pediatric healthcare institutions to effectively address patients’ unmet social needs. Simultaneously, there is increasing policy and payer pressure to implement screening protocols for social risk factors—such as food and housing insecurity, financial strain, and unsafe environments—within pediatric healthcare. Although the intent to bring equitable care to families is paramount, it remains unclear what effect standardized social risk screening has on engagement with resources and whether the screening process itself unintentionally introduces disparity.

Over the past decade evidence has built in favor of using self-administered tablet-based screeners to provide anonymity, offering audio-assist and/or pictures to overcome literacy barriers, and applying introductory and sensitive language to decrease concerns about being targeted for screening. Our study, “Food for Thought: A Randomized Trial of Food Insecurity Screening in the Emergency Department,” found that tablet-based written screening was both preferred by families and maximized elicitation of food insecurity as compared to verbal face-to-face screening. While we found overall high reported comfort with screening, it is notable that comfort levels were lower among those reporting food insecurity. In our related qualitative work, caregivers expressed fear of stigma or negative repercussions as a consequence of reporting social risk. This and other studies emphasize the potential for unintended consequences and have led to a growing interest in a model of universally offered social assistance, rather than one of screening and intervention.