Potential pediatric healthcare consequences of not getting help for disclosed social needs

OBJECTIVE: To assess the association between double-loss (disclosure of social needs without receiving assistance) with low-income children's healthcare utilization outcomes. METHODS: Data were from a hybrid effectiveness-implementation trial evaluating a social needs screening and referral intervention (WE CARE) implemented in three community health centers. WE CARE included 3 components: (1) social risk/need screener assessing parental desire for assistance with unmet social needs; (2) resource information referrals; and (3) patient navigator. A family was defined as experiencing double-loss if at their child's well-child visits (WCV) from birth to age 3, there was at least one scanned screener with a request for help without a referral documented in the EHR. Multiple logistic regression was used to compare rates of double-loss with adherence to WCV and immunization schedules. RESULTS: Among the cohort of children (n=403), 43.4% were Black, 21.1% Latino/a/e, and 13.9% Asian. Overall, 40.5% of parents experienced double-loss. Families who experienced double-loss had fewer reported social needs (0.3 vs. 1.5, p<0.001). Children whose families' experienced double-loss had significantly lower WCV adherence ratios in the first 3 years of life (0.40 vs 0.43, p<0.0001). Similarly, the immunization adherence ratio for children was significantly lower for families who experienced double-loss than for families who did not experience double-loss (0.79 vs 0.92, p <.0001). CONCLUSIONS: Families experienced double-loss had significantly lower WCV and immunization adherence. These exploratory findings carry significant implications for pediatric practice, guidelines and health policy.