title: A randomized trial on screening for social determinants of health: the iScreen study.
abstract: BACKGROUND
  There is growing interest in clinical screening for pediatric social determinants of health, but little evidence on formats that maximize disclosure rates on a wide range of potentially sensitive topics. We designed a study to examine disclosure rates and hypothesized that there would be no difference in disclosure rates on face-to-face versus electronic screening formats for items other than highly sensitive items.
  
  
  METHODS
  We conducted a randomized trial of electronic versus face-to-face social screening formats in a pediatric emergency department. Consenting English-speaking and Spanish-speaking adult caregivers familiar with the presenting child's household were randomized to social screening via tablet computer (with option for audio assist) versus a face-to-face interview conducted by a fully bilingual/bicultural researcher.
  
  
  RESULTS
  Almost all caregivers (96.8%) reported at least 1 social need, but rates of reporting on the more sensitive issues (household violence and substance abuse) were significantly higher in electronic format, and disclosure was marginally higher in electronic format for financial insecurity and neighborhood and school safety. There was a significant difference in the proportion of social needs items with higher endorsement in the computer-based group (70%) than the face-to-face group (30%).
  
  
  CONCLUSIONS
  Pediatric clinical sites interested in incorporating caregiver-reported socioeconomic, environmental, and behavioral needs screening should consider electronic screening when feasible, particularly when assessing sensitive topics such as child safety and household member substance use.
authors.affiliation: Department of Family and Community Medicine, and Laura.Gottlieb@ucsf.edu.
authors.forename: Laura
authors.initials: L
authors.lastname: Gottlieb
authors.affiliation: Department of Family and Community Medicine, and.
authors.forename: Danielle
authors.initials: D
authors.lastname: Hessler
authors.affiliation: Department of Psychiatry, University of California, San Francisco, San Francisco, California; and.
authors.forename: Dayna
authors.initials: D
authors.lastname: Long
authors.affiliation: Department of Psychiatry, University of California, San Francisco, San Francisco, California; and.
authors.forename: Anais
authors.initials: A
authors.lastname: Amaya
authors.affiliation: Department of Family and Community Medicine, and.
authors.forename: Nancy
authors.initials: N
authors.lastname: Adler
mesh_terms: D000328:Adult; D002648:Child; D034201:Computers, Handheld; D030881:Disclosure; D017579:Domestic Violence / Q000523:psychology; D005260:Female; D006306:Health Surveys; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008403:Mass Screening; D020380:Needs Assessment; D012495:San Francisco; D012650:Self Disclosure; D064890:Social Determinants of Health / Q000145:classification; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000523:psychology
keywords: emergency medicine; psychosocial issues