Jury Out on How Best to Screen for Health-Related Social Needs

By Megan Brooks

August 05, 2020

NEW YORK (Reuters Health) - Screening for health-related social needs, such as housing, food and transportation problems, are increasingly being incorporated into clinical care but the best way to accomplish this remains unclear, a new study suggests.

"I think the bottom line of this study is to encourage clinicians and health systems to be thoughtful as more systematic screening for health-related social needs is implemented in health systems and in electronic medical records," Dr. Kristin Ray of the University of Pittsburgh and Children's Hospital of Pittsburgh told Reuters Health by email.

"While it's clear that health-related social needs have profound impact on child health, there are still questions about how best to incorporate such screening into everyday practice - who should ask the questions, which questions do we ask, what information about the screening process do families need up front, and what happens after the screening process," she said.

Dr. Ray and her colleagues had 146 caregivers of children presenting for nonurgent ED care - a population anticipated to have high social needs - complete an online survey on health-related social needs.

Forty-two caregivers (29%) endorsed one or more health-related social needs, most commonly food insecurity and transportation difficulties, but 10 (24%) also skipped one or more social needs questions, the researchers report in Pediatrics.

Eighty-five caregivers (58%) denied all social needs, while 19 (13%) did not endorse any social needs but also failed to answer at least one survey question. Of these 19 caregivers, 15 (79%) specifically selected the response "I choose not to answer this question" at least once, while the remaining four left at least one question blank.

A concerning finding, say the researchers, is that caregivers who skipped or chose not to answer social-needs screening questions appeared to have fewer social supports and were less well connected to primary care than those either endorsing social needs or denying all social needs.

"Based on our findings, if someone skips questions, it appears likely to be worth asking a follow-up question or offering resources rather than assuming the need does not exist. Especially in systems where screening is becoming more automated within electronic questionnaires, skipped questions should likely be flagged differently than 'yes' or 'no' responses," Dr. Ray told Reuters Health.

During the ED visit, the researchers provided all caregivers with a list of community resources to help with health and social needs. Among the 61 caregivers contacted by phone two weeks after the ED visit, only 37% of those who reported a social need said they used the resources.

"Attention to health-related social needs is essential in all clinical encounters," Dr. Ray said, "and more systematic screening in recent years has shown that there are depths of previously unrecognized needs. I think it is essential that we address health-related social needs in all care settings, but that we also continue to recognize that there are multiple ways to accomplish this and the right answer might vary across different settings."

SOURCE: https://bit.ly/2Xs1ojr Pediatrics, online August 4, 2020.