Multiple Behavior Change Intervention to Improve Detection of Unmet Social Needs and Resulting Resource Referrals

Acad Pediatr. 2016 Mar;16(2):168-74. doi: 10.1016/j.acap.2015.06.001. Epub 2015 Jul 14.


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.

Keywords: health status disparities; poverty; social determinants of health; socioeconomic factors; vulnerable populations.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Behavior Therapy
  • Domestic Violence
  • Emigration and Immigration
  • Female
  • Food Supply
  • Health Status Disparities
  • Housing
  • Humans
  • Insurance, Health
  • Internship and Residency*
  • Legal Guardians
  • Male
  • Mass Screening
  • Needs Assessment*
  • Pediatrics / education*
  • Poverty
  • Referral and Consultation*
  • Social Determinants of Health*
  • Socioeconomic Factors