title: Can a video curriculum on the social determinants of health affect residents' practice and families' perceptions of care?
abstract: BACKGROUND
  Screening and management of the social determinants of health (SDH) are critical for child health promotion. We sought to evaluate the impact of a facilitated video curriculum on resident SDH screening competence, parental perceptions of resident practice, resident-initiated referrals to a medical-legal partnership (MLP), and formula distribution to food-insecure families.
  
  
  METHODS
  This was a pre-post study with concurrent control performed at a large pediatric residency program. Second- and third-year residents were assigned to control and intervention groups on the basis of their continuity clinic day. The curriculum included videotaped vignettes of screening for SDH and a "day in the life" series of families describing the impact of intervention on their lives. Residents completed self-assessments on screening competence and resource knowledge. After a well-child encounter, families (3 per resident) assessed their level of trust and respect for the resident and the number of SDHs screened for. MLP referral rates and formula distribution were compared.
  
  
  RESULTS
  The intervention group's self-assessed competence in screening for housing, benefits, and educational concerns was significantly higher compared to controls (each P ≤ .05). Parents' rating of trust and respect was high and did not differ between groups. Screening for each SDH was higher in the intervention group with domestic violence (odds ratio 2.16, 95% confidence interval 1.01-4.63) and depression (odds ratio 2.63, 95% confidence interval 1.15-5.99), reaching statistical significance. MLP referral rates increased (P = .06), and formula distribution (P = .02) reached statistical significance in the intervention group.
  
  
  CONCLUSIONS
  This SDH video curriculum improved resident self-assessed screening competence, parental perception of screening, and both MLP referrals and formula distribution.
authors.affiliation: Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: Melissa.klein@cchmc.org.
authors.forename: Melissa D
authors.initials: MD
authors.lastname: Klein
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Alcamo
authors.affiliation: Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Beck
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: O'Toole
authors.affiliation: Division of Education and Learning, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Daniel
authors.initials: D
authors.lastname: McLinden
authors.affiliation: Child HeLP, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Henize
authors.affiliation: Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kahn
mesh_terms: D000328:Adult; D002648:Child; D002651:Child Advocacy / Q000193:education*; D002983:Clinical Competence; D003479:Curriculum; D017579:Domestic Violence; D005260:Female; D005523:Food Supply; D006798:Housing; D006801:Humans; D007396:Internship and Residency; D008297:Male; D009820:Ohio; D010290:Parents / Q000193:education / Q000523:psychology*; D010372:Pediatrics / Q000193:education*; D010817:Physician-Patient Relations; D012647:Self-Assessment; D064890:Social Determinants of Health; D012946:Social Welfare; D012959:Socioeconomic Factors; D014743:Videotape Recording
keywords: graduate medical education; medical–legal partnership; pediatric primary care center; pediatrics; social determinants of health; well-child check