title: Addressing social determinants of health at well child care visits: a cluster RCT.
abstract: OBJECTIVE
  To evaluate the effect of a clinic-based screening and referral system (Well Child Care, Evaluation, Community Resources, Advocacy, Referral, Education [WE CARE]) on families' receipt of community-based resources for unmet basic needs.
  
  
  METHODS
  We conducted a cluster randomized controlled trial at 8 urban community health centers, recruiting mothers of healthy infants. In the 4 WE CARE clinics, mothers completed a self-report screening instrument that assessed needs for child care, education, employment, food security, household heat, and housing. Providers made referrals for families; staff provided requisite applications and telephoned referred mothers within 1 month. Families at the 4 control community health centers received the usual care. We analyzed the results with generalized mixed-effect models.
  
  
  RESULTS
  Three hundred thirty-six mothers were enrolled in the study (168 per arm). The majority of families had household incomes <$20,000 (57%), and 68% had ≥ 2 unmet basic needs. More WE CARE mothers received ≥ 1 referral at the index visit (70% vs 8%; adjusted odds ratio [aOR] = 29.6; 95% confidence interval [CI], 14.7-59.6). At the 12-month visit, more WE CARE mothers had enrolled in a new community resource (39% vs 24%; aOR = 2.1; 95% CI, 1.2-3.7). WE CARE mothers had greater odds of being employed (aOR = 44.4; 95% CI, 9.8-201.4). WE CARE children had greater odds of being in child care (aOR = 6.3; 95% CI, 1.5-26.0). WE CARE families had greater odds of receiving fuel assistance (aOR = 11.9; 95% CI, 1.7-82.9) and lower odds of being in a homeless shelter (aOR = 0.2; 95% CI, 0.1-0.9).
  
  
  CONCLUSIONS
  Systematically screening and referring for social determinants during well child care can lead to the receipt of more community resources for families.
authors.affiliation: Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts; arvin.garg@bmc.org.
authors.forename: Arvin
authors.initials: A
authors.lastname: Garg
authors.affiliation: Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts;
authors.forename: Sarah
authors.initials: S
authors.lastname: Toy
authors.affiliation: Boston University School of Public Health, Department of Biostatistics, Boston, Massachusetts; and.
authors.forename: Yorghos
authors.initials: Y
authors.lastname: Tripodis
authors.affiliation: Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts;
authors.forename: Michael
authors.initials: M
authors.lastname: Silverstein
authors.affiliation: Center for Community Health Education, Research and Service, Northeastern University, Boston, Massachusetts.
authors.forename: Elmer
authors.initials: E
authors.lastname: Freeman
mesh_terms: D000328:Adult; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D016000:Cluster Analysis; D003151:Community Health Centers; D019058:Community Networks; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening; D020380:Needs Assessment; D011320:Primary Health Care; D012017:Referral and Consultation; D064890:Social Determinants of Health; D012947:Social Work; D011795:Surveys and Questionnaires; D014481:United States; D035862:Vulnerable Populations
keywords: community-based resources; screening; social determinants of health; well child care