Published online June 1, 2007
PEDIATRICS Vol. 119 No. 6 June 2007, pp. e1332-e1341 (doi:10.1542/10.1542/peds.2006-1505)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Fleegler, E. W.
Right arrow Articles by Muret-Wagstaff, S.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Fleegler, E. W.
Right arrow Articles by Muret-Wagstaff, S.
Related Collections
Right arrow Office Practice
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

ARTICLE

Families' Health-Related Social Problems and Missed Referral Opportunities

Eric W. Fleegler, MD, MPHa,b, Tracy A. Lieu, MD, MPHb,c,d, Paul H. Wise, MD, MPHe and Sharon Muret-Wagstaff, PhD, MPAb,d

a Division of Emergency Medicine
d Department of Medicine, Children's Hospital Boston, Boston, Massachusetts
b Harvard Medical School, Boston, Massachusetts
c Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care, Boston, Massachusetts
e Department of Pediatrics, Stanford University School of Medicine, Stanford, California

OBJECTIVES. The objectives of this study were to characterize (1) families' cumulative burden of health-related social problems regarding access to health care, housing, food security, income security, and intimate partner violence; (2) families' experiences regarding screening and referral for social problems; and (3) parental acceptability of screening and referral.

METHODS. We surveyed 205 parents of children who were 0 to 6 years of age and attended 2 urban pediatric clinics for a well-child visit using a self-administered, computer-based questionnaire. The questionnaire included previously validated questions about health-related social problems and new questions about screening and referral in the past 12 months.

RESULTS. A total of 205 (79%) of 260 eligible families participated. Eighty-two percent of families reported ≥1 health-related social problem; 54% experienced problems in ≥2 social domains. Families experienced similar types and frequencies of problems despite demographic differences between clinics. One third of families reported no screening in any domain in the previous 12 months. Of 205 families, 143 (70%) identified at least 1 need for a referral; 101 (49%) expressed ≥1 unmet referral need. Of families who reported receiving referrals, 115 referrals were received by 79 families; of the referrals made, 63% (73 of 115) led to contact with the referral agency, and 82% (60 of 73) of the referral agencies were considered helpful. A computer-based system in a pediatrician's office for future screening and referral for health-related social problems was deemed acceptable by 92% of parents.

CONCLUSIONS. Urban children and families reported a significant burden of health-related social problems yet infrequent pediatric screening or referral for these problems. Of families who reported receiving referrals, a majority contacted the recommended agencies and found them helpful. This study also demonstrates the feasibility of using a computer-based questionnaire to identify health-related social problems in a routine outpatient clinic setting.

Key Words: social problems • screening • referral • access to health care • housing • hunger • income • domestic violence • computer • pediatric

Abbreviations: AAP—American Academy of Pediatrics • HRSP—health-related social problem • AHP—academic health practice • CHC—community health center • CCHIP—Childhood Community Hunger Identification Project • FPL—federal poverty level • CI—confidence interval

Accepted Nov 27, 2006.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?