title: Multiple Behavior Change Intervention to Improve Detection of Unmet Social Needs and Resulting Resource Referrals.
abstract: OBJECTIVE
  It is critical that pediatric residents learn to effectively screen families for active and addressable social needs (ie, negative social determinants of health). We sought to determine 1) whether a brief intervention teaching residents about IHELP, a social needs screening tool, could improve resident screening, and 2) how accurately IHELP could detect needs in the inpatient setting.
  
  
  METHODS
  During an 18-month period, interns rotating on 1 of 2 otherwise identical inpatient general pediatrics teams were trained in IHELP. Interns on the other team served as the comparison group. Every admission history and physical examination (H&P) was reviewed for IHELP screening. Social work evaluations were used to establish the sensitivity and specificity of IHELP and document resources provided to families with active needs. During a 21-month postintervention period, every third H&P was reviewed to determine median duration of continued IHELP use.
  
  
  RESULTS
  A total of 619 admissions met inclusion criteria. Over 80% of intervention team H&Ps documented use of IHELP. The percentage of social work consults was nearly 3 times greater on the intervention team than on the comparison team (P < .001). Among H&Ps with documented use of IHELP, specificity was 0.96 (95% confidence interval 0.87-0.99) and sensitivity was 0.63 (95% confidence interval 0.50-0.73). Social work provided resources for 78% of positively screened families. The median duration of screening use by residents after the intervention was 8.1 months (interquartile range 1-10 months).
  
  
  CONCLUSIONS
  A brief intervention increased resident screening and detection of social needs, leading to important referrals to address those needs.
authors.affiliation: Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Mo; Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Mo. Electronic address: jdcolvin@cmh.edu.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Colvin
authors.affiliation: Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Mo; Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Mo.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Bettenhausen
authors.affiliation: Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Calif.
authors.forename: Kaston D
authors.initials: KD
authors.lastname: Anderson-Carpenter
authors.affiliation: Work Group for Community Health and Development, University of Kansas, Lawrence, Kans.
authors.forename: Vicki
authors.initials: V
authors.lastname: Collie-Akers
authors.affiliation: Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Mo; Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Mo.
authors.forename: Laura
authors.initials: L
authors.lastname: Plencner
authors.affiliation: Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Mo; Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Mo.
authors.forename: Molly
authors.initials: M
authors.lastname: Krager
authors.affiliation: Department of Social Work, Children's Mercy Hospitals and Clinics, Kansas City, Mo.
authors.forename: Brooke
authors.initials: B
authors.lastname: Nelson
authors.affiliation: Department of Social Work, Children's Mercy Hospitals and Clinics, Kansas City, Mo.
authors.forename: Sara
authors.initials: S
authors.lastname: Donnelly
authors.affiliation: Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Mo; Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Mo.
authors.forename: Julia
authors.initials: J
authors.lastname: Simmons
authors.affiliation: Turner House Children's Clinic, Kansas City, Kans.
authors.forename: Valeria
authors.initials: V
authors.lastname: Higinio
authors.affiliation: Departments of Pediatrics and Health Policy & Management, University of California, Los Angeles, Calif; Children's Discovery and Innovation Institute, Mattel Children's Hospital UCLA, Los Angeles, Calif; RAND Health, The RAND Corporation, Santa Monica, Calif.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Chung
mesh_terms: D000328:Adult; D001521:Behavior Therapy; D017579:Domestic Violence; D004641:Emigration and Immigration; D005260:Female; D005523:Food Supply; D054624:Health Status Disparities; D006798:Housing; D006801:Humans; D007348:Insurance, Health; D007396:Internship and Residency; D007872:Legal Guardians; D008297:Male; D008403:Mass Screening; D020380:Needs Assessment; D010372:Pediatrics / Q000193:education*; D011203:Poverty; D012017:Referral and Consultation; D064890:Social Determinants of Health; D012959:Socioeconomic Factors
keywords: health status disparities; poverty; social determinants of health; socioeconomic factors; vulnerable populations