Assistant Professor Children's Hospital of Philadelphia University of Pennsylvania School of Medicine Philadelphia, Pennsylvania, United States
Background: Children with complex chronic conditions (CCC), conditions involving multiple systems expected to last >1 year, represent a signficant proportion of pediatric hospitalizations. CCC, caregiver social needs, and health care spending are interrelated. While it is clear that addressing social needs of hospitalized children with CCC is important, prior research suggests that standardized approaches are lacking. Data to inform improvements in addressing social needs of hospitalized children with CCC are needed.
Objective: Describe the prevalence and nature of social needs among hospitalized children with CCC. Compare social needs between hospitalized children with and without CCC.
Design/Methods: As part of a quality improvement project, we implemented a standard social needs questionnaire over a 5-month period at an urban pediatric hospital on one inpatient unit. The unit has 22 beds; 10 general pediatrics and 12 complex care. We derived questions about food access, utilities, transportation, caregiver depression, and intimate partner violence from Accountable Health Communities tool and Partner Violence Screen (Table 1). Inclusion criteria included English-speaking caregiver present at bedside during unit social worker’s hours, and no impending discharge or transfer. Staff explained screener, and provided tablet for consenting caregivers to self-administer screener in REDCap. We entered demographic data from the electronic health record into REDCap. All caregivers received information about our web-based resource map, and caregivers with positive screen met with social work. We performed descriptive statistics and logistic regression using SAS.
Results: 147 caregivers were screened; 84 had children with CCC (Table 2). 42% of the child with CCC group had an identified social need (Table 3). The most common needs were positive depression screen response (32%) and food (23%). Compared to caregivers of children without CCC, CCC group were more likely to identify ≥1 need, utility needs, and positive depression screen response (Table 4). Conclusion(s): Standardized screening identified social needs in >4/10 caregivers in the CCC group. Depression screens were positive at rates higher than comparison group of parents with hospitalized children without CCC. Given the additional burdens of caring for medically complex children, initiatives to support caregiver well-being are needed for this population, as are resources to support financial needs (food, utilities). Additional caregiver support and dissemination strategies are currently being explored.
Table 1: Standardized social needs questionnaire content
Table 2: Demographic and clinical characteristics of caregivers screened for social needs overall and by complex chronic condition (CCC) status.
Table 3: Social needs identified on standardized screening tool in the total population and by complex chronic condition (CCC) status
Table 4: Odds of having an identified social need among patients with complex chronic condition compared to patients who do not have a complex chronic condition.
Authors/Institutions: Kristine Fortin, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States; Leigh Wilson-Hall, Children's Hospital of Philadelphia Policy Lab, Philadelphia, Pennsylvania, United States; Kimberly St Lawrence, Children's Hospital of Philadelphia, Philadelphoa, Pennsylvania, United States; Stuti Tank, Drexel Medical School, Philadelphia, Pennsylvania, United States; Arleen Juca, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States; Philip Scribano, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States