Scholarly Sessions

Public Health

Health Equity/Social Determinants of Health

Critical Care

Advocacy Pathway

Identifying Critical Social Threats in Critically Ill Children: Considerations for Social Determinants of Health Screening in the PICU

Chair(s)

• 

  Erin Paquette, MD, JD, MBe, HCEC

  Assistant Professor
  Pediatric Critical Care
  Northwestern University Feinberg School of Medicine/Ann & Robert H Lurie Children's Hospital of Chicago
  Chicago, Illinois, United States

Critically ill children may be particularly vulnerable to social determinants of health (SDOH) across the continuum of illness. Substandard living conditions may predispose children to higher risk of critical disease; long-standing toxic stress may worsen illness severity; limited family and community infrastructure could hinder recovery and potentiate post-PICU morbidity. The full impact on critical illness and outcomes is poorly understood, as screening has not been widely implemented.

Universal screening for SDOH in the acute care setting is recommended by the American Academy of Pediatrics. Routine screening for social conditions impacting health and disease can be justified under Wilson and Jungner’s criteria including: recognized need, clear screening objectives, a target population, evidence of effectiveness, ability to test, quality assurance, ability to minimize risks, and informed choice. Identifying socially disadvantaged children and families may improve outcomes by 1) mitigating parental stress through resource provision; 2) preventing hospital readmission and 3) decreasing morbidity after discharge by improving access to post-hospital care that meets needs of limited-resource families. Despite potential benefits, screening is not routinely done.

Several barriers to screening exist. Screening can uncover psychosocial trauma and requires training in trauma informed approaches. Time to screen can be challenging in the busy PICU setting. Clinic and community resources may vary between institutions, and identification of unmet needs with inability to provide resources could lead to unnecessary “labeling” of families. To reduce risk of and improve outcomes from critical illness, these concerns must be balanced against the need to describe the scope of the problem to generate additional resources. Identifying appropriate ways to screen is of critical importance. Using existing tools in emergent settings may be challenging, creating an opportunity for development of additional tools.

We argue a strengths-based screening approach may be an effective means of identifying needs while also increasing willingness to participate. Strengths-based tools, however, do not exist. This panel will discuss creation, validation and implementation of a strengths-based, resilience-oriented and stakeholder-informed social history screening tool for use in the acute care setting, through multidisciplinary collaboration, including patient and family engagement.

Presentations:

• 9:00 AM - 9:20 AM US CT

  The impact of social determinants of health across the spectrum of critical illness
  

  Presenter: Manzi Akande, MD MPH – University of Oklahoma Health Sciences Center
• 9:20 AM - 9:40 AM US CT

  A justice based argument for screening for social determinants of health across the continuum of critical illness
  

  Presenter: Erin Paquette, MD, JD, MBe, HCEC – Northwestern University Feinberg School of Medicine/Ann & Robert H Lurie Children's Hospital of Chicago
• 9:40 AM - 10:05 AM US CT

  Barriers to traditional screening tools for social determinants of health
  

  Presenter: Ericka Fink, MD, MS – UPMC Children's Hospital of Pittsburgh
• 10:05 AM - 10:30 AM US CT

  A proposal for developing a strength based screening tool for social determinants of health
  

  Presenter: Katherine Slain, DO – UH Rainbow Babies and Children's Hospital
• 10:30 AM - 11:30 AM US CT

  Break
  

  Presenter: Belinda Thomas
• 11:30 AM - 12:00 PM US CT

  Click for Live Q&A: Identifying Critical Social Threats in Critically Ill Children: Considerations for Social Determinants of Health Screening in the PICU
  

  Presenter: Belinda Thomas