From screening to support: Crafting social needs response systems that work for families

In this issue of Pediatrics, Garg et al1 detail findings from a multi-institutional stepped-wedge cluster trial using a type 2 hybrid effectiveness-implementation design. The study sought to assess the impact of the Well-Child Care Evaluation, Community Resources, Advocacy, Referral, Education (WE CARE) social intervention. WE CARE—inclusive of a health-related social need (HRSN) screener and access to family resource books with referral handouts—was significantly associated with increased rates of screening and referral but not enrollment in community resources. Study strengths include its implementation across heterogeneous sites nationwide and pragmatic assessment of intervention effectiveness in real-world settings. Mixed findings led the authors to “temper expectations” relating to impacts of social care approaches implemented within medical settings and to caution that current approaches may be insufficient to fully address identified needs.2 Even so, the authors suggest that discussion of HRSNs, with or without direct connection to resources, could affect health outcomes through indirect pathways, including enhancement of “authentic healing relationships.”1,3