Universal health-related social needs screening in a paediatric rheumatology clinic

OBJECTIVES: Health-related social needs (HRSN) have a significant impact on health outcomes. While screening is prevalent in paediatric primary care settings, little evidence exists regarding the feasibility of HRSN screening in paediatric rheumatology clinics. Individuals with paediatric rheumatic disease have frequent longitudinal visits, therefore it is important to understand social needs that may hinder optimal health outcomes in this population. The objectives of this study were to understand the burden of HRSN and to contextualize the feasibility of universal HRSN screening in a busy paediatric rheumatology clinic. 

METHODS: The study team secured funding for a full-time social worker and developed a needs assessment questionnaire (NAQ) through an iterative process. The paper-based NAQ was distributed by administrative clinical staff to all patients at each in-person visit. Medical providers returned completed NAQs to a designated collection tray. The responses were reviewed and analysed. The social worker addressed positive screens among families who opted in for contact. 

RESULTS: More than 1/3 of patients returned an NAQ (985/2819), 604/985 (61%) of which revealed one or more concerns. The most frequent social concern was school or work related. The social worker responded by phone or patient electronic portal message to returned NAQs that identified unmet needs. 

CONCLUSION: A school or work concern was a frequent health-related social need in the paediatric rheumatology clinic. The prevalence of unmet HRSN, despite primary care access, shows the importance of screening in rheumatology clinics. Sustainable funding is needed to scale efforts to assess and address them.