Wonder

Research Outline

Prepared for Ify A. | Delivered June 19, 2020

Social Determinants of Health (SDoH) - Pediatrics and Child Healthcare

Goals

To understand the increasing importance of the role Social Determinants of Health (SDoH) and how it is impacting the world of pediatrics and child healthcare. An ideal response would include One: how pediatricians feel about SDoH, Two: how they are applying that to their practice and patients, Three: any new groups, services, policies, and technologies that are being considered and/or put in place in pediatrics specifically to address SDoH, Four: whether SDoH is gaining more or less attention today compared to in the past, and Five: any impact that SDoH is having on how pediatricians practice medicine.

Early Findings

Please note! We were not provided a geographic focus so we assumed a United States view. If a more broad approach is desired, for example, a global focus, this would have to be clearly communicated to us in any reply.
According to a 2019 report from Public Agenda and the United Hospital Fund, building patient trust and strong patient-provider relationships will be essential during social determinants of health (SDOH) screenings in pediatric settings. "Establishing a positive rapport between a pediatric patient’s parents and the provider will help assuage parental concerns that they will be judged or reported to child protective services", the report authors stated.
The conclusion of this report stated: "Pediatricians, along with other health care providers, are increasingly being asked to identify and help address social determinants of health. These efforts represent a transition for both the pediatricians and for parents. It is crucial for pediatricians to understand parents’ needs, concerns and goals as both parties adjust to this expanded vision of pediatric care. Pediatricians and their staffs must work with parents to build their comfort with disclosing information about social stressors, particularly those that are most sensitive."
"The medical industry has become increasingly concerned with the social determinants of health, asserting that comprehensive screenings are beneficial for referring patients and families to community health benefits. Doing so is particularly important in pediatric settings, many providers agree, considering the impact that adverse childhood events (ACEs) and other social challenges can have going into adulthood."
According to David Schleifer, PhD, vice president, director of research at Public Agenda, “parents were afraid that if they shared information about their lives with their pediatrician they might be investigated or even lose their kids. Parents told us that physicians must build trust if they want parents to open up about their lives.”
More research about the social determinants of health in pediatric settings will be necessary to improve patient no-show rates for well-child visits, according to new data in the Annals of Family Medicine.
The American Academy of Pediatrics "recommends surveillance for risk factors related to social determinants of health during all patient encounters. Practices can use a written screener or verbally ask family members questions about basic needs such as food, housing, and heat."
Six resources aimed at providing information and tools on screening, referral, and follow-up for social determinants of health and managing psychosocial concerns are Early Childhood Adversity, Toxic Stress, & the Role of the Pediatrician: Translating Developmental Science into Lifelong Health, Addressing Food Insecurity: A Toolkit for Physicians, Poverty and Child Health, Trauma Toolbox for Primary Care, Avoiding the Unintended Consequences of Screening for Social Determinants of Health, and The EveryONE Project. All six of these resources can be found on the American Academy of Pediatrics website.
The American Academy of Pediatrics (AAP) Council on Community Pediatrics (COCP) has been advocating for an increased role of pediatricians in addressing social determinants of health (SDOH) for pediatric patients and their communities for over a decade. 
To aid pediatricians in addressing this seemingly daunting task, COCP developed web-based resources that accompanied the policy statement and technical report to help with screening and local resource determination (www.aap.org/poverty). And while there is increased traction and evidence supporting SDOH screening,  the practice is far from universal and challenges remain.
The authors of this report identify two opportunities that new payment systems present to actually make addressing SDOH easier: engaging diverse sectors to improve child health and the Massachusetts Medicaid-supported integrated SDOH care model.
Summary Of Our Early Findings Relevant To The GoalsOur initial hour of research was spent gathering some data that addressed some areas of the five part question asked, as well as ensuring there was publicly available data that could provide the required data.
As mentioned at the top of the document, a geographic focus was not provided to us, so we assumed a United States focus. If a more broad approach is desired, for example, a global focus, this would have to be clearly communicated to us in any reply.
Please select one or more of the options provided in the proposed scoping section below.