Seeking Social Determinant Strategies in Pediatric Settings

Even before COVID put even more pressure on clinicians and the patients they serve, Social Determinants of Health (SDoH) factors have been shaping communications and assumptions across clinical settings for years. This can have an adverse impact, particularly in pediatric practices where the third party in the relationship between clinician and patient is the parent or guardian.

As a definition for what constitutes a SDoH, we like the definition used by the U.S. Department of Health and Human Services, which is as follows: “Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affects a wide range of health, functioning, and quality-of-life outcomes and risks.”[1]

Socioeconomic impact on the health of specific low-income and minority populations is stark and undeniable: lower-income families are more likely to be underinsured, often living in food deserts, with statistically higher rates of chronic conditions like asthma, diabetes, and obesity[2].

Despite their indisputable impact, screening for SDOH presents challenges. In a 2019 article citing a study done by Public Agenda and United Hospital Fund[3], SDoH screenings by pediatric practitioners during wellness visits were identified as having the potential to erode trust and relationships with patients’ parents and guardians, which could lead ultimately to negative outcomes for the young patients themselves.

SDoH screenings during these visits are often misconstrued by parents and guardians as attempts to uncover behavior that would be referred to social services. Additionally, clinicians were often unaware of the SDoH factors impacting families’ ability to manage their children’s chronic conditions, creating misconceptions that complicated effective care. This combination makes for enormously difficult conditions in which to define paths to better outcomes.

It becomes imperative to augment, outside the typical SDoH screening process, the identification of root causes interfering with the most beneficial outcomes in pediatric populations most at risk.

Making the case for patient research as the path to SDoH solutions

In our own research practice, we have seen this firsthand. A client engaged us to uncover insights that would shape communications and messaging aimed at the importance of pediatric wellness visits. The underlying assumptions were that patients’ parents were either unable to access or unaware of options, for transportation to wellness visits or were cavalier about the importance of the visits themselves.

To say the truth was complicated is an understatement. But root cause analysis uncovered some provider biases and a disconnect in awareness of the realities of the daily lives of parents of pediatric patients. It also uncovered misconceptions about parental recognition of the impact of wellness appointments missed.

Far from being negligent, as in many cases was assumed, our research revealed that parents in this segment were often taking children to specialists or emergency room visits to manage chronic conditions, necessitating extensive time off from work. This translated to potentially lost wages and even dismissal, where there was no safety net. Wellness visits, while recognized as extremely important, were seen by many patients’ parents as less important compared to other provider relationships.

Once the root cause was identified, we collaborated with the client to put in place education for clinicians around nuanced SDoH factors impacting wellness visits. We also helped the client think about alternatives that would accomplish well-visit objectives in other ways. These included evolving other settings in which to assess developmental milestones, ensure progress on vaccination schedules, and guide this population towards healthier habits through education. It also led to communication mechanisms to steer families toward community-based support.

Fast forward to 2022, when younger pediatric patients are still not eligible to receive COVID vaccination, and the more transmissible Omicron variant is dramatically increasing infection rates across all age groups. Clinicians have even less capacity for wellness visits, even as underserved populations need alternatives to pursue them. Amongst the working poor, “work from home” has often not been an option and the lack of options for childcare has put additional burdens on families just trying to survive.

This creates an even greater need to forge more effective relationships between practitioners and the families of their pediatric patients, particularly for lower-income and Medicaid-insured populations.

Once we are past the peak of the current COVID crisis, and the industry turns to the future, how can healthcare providers determine which initiatives for wellness will work best with their patient populations, their practitioners, and their partners in community public health? Our point of view is shared by Suzanne Brundage, director of the United Hospital Fund’s Director of Children’s Health Initiative, who in that same article said the following:

“Parents bring their young children to the pediatrician up to 11 times within the first two years of life, and each of these visits offers an opportunity to identify unmet social needs and coordinate care with community-based services…As screening for social determinants of health becomes more common in pediatric practices, qualitative and quantitative research can help us understand and improve how parents experience these screenings.”

At Simply Strategy, our focus is to provide stakeholders across the healthcare landscape with research and strategy that can lead to more effective programs. Our own purpose: “We specialize in helping organizations whose mission it is to help others.”

If the population you serve is impacted by SDoH factors and you want all your initiatives, including clinical screening programs for SDoH, to lead to better outcomes, please reach out to discuss how our consultative approach to research can help your organization achieve that goal.

[1] Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. [2] Braveman, Paula, et al. "What is health equity?." Behavioral Science & Policy 4.1 (2018): 1-14. [3] Schleifer, David. "It’s about Trust: Low‐Income Parents’ Perspectives on How Pediatricians Can Screen for Social Determinants of Health." Health Services Research 55 (2020): 134-135.