PEDIATRIC CLINICIANS' PRACTICE OF ADDRESSING UNMET NEEDS OF SOCIAL DETERMINANTS OF HEALTH IN AN OUTPATIENT SETTING: AN EVALUATION STUDY

Children living in families that faced challenges with social determinants of health (SDOH) are at higher risk of having adverse childhood experiences (ACEs). Children exposed to abuse, witness domestic violence, and grow up in a household where family members are mentally ill, substance abusers or imprisoned, are substantially more likely to have attempted suicide, become alcoholics, and use injected street drugs by the time they are adults. One way to prevent and mitigate the impacts of ACEs and substantial risks is to screen for SDOH in the pediatric care setting. SDOH screening is uncommon in pediatric clinical settings. Yet, interventions in pediatric primary care settings are feasible and can favorably affect clinical practices and patients' and their families' outcomes. Most pediatric outpatient clinical models are not set up to adequately address these potential risks to health. Pediatric clinicians' practice of screening, recognizing, and referring high-risk patients and their caregivers with psychosocial issues related to SDOH to community resources is not widely studied. The present study aims to evaluate and understand the current practice of screening and addressing SDOH in a pediatric care setting. After chart reviews and data analysis with a randomly selected sample (N=376), this dissertation identified 39% (149 charts) presented unmet concerns for SDOH identified compared to 48% (179) without a concern. Of the 39% presenting with unmet needs, only 6.5% (33 charts) had some form of help provided by the clinician. There were 126 (82%) patients who demonstrated missed opportunities and the necessity for pediatric clinicians to address the unmet needs of SDOH. To address the identified knowledge gaps among clinicians, the researcher suggests that recommendations should include ongoing training of the protocol and procedure to address the SDOH identified based on the Family Resource Survey (FRS), prompting functions as a hard stop in the EPIC electronic health records, documentation of FRS concerns, and response as a quality metric in the primary care clinic. Pediatric clinicians could vastly benefit from the suggested recommendations aimed at improving their ability to aid in the mitigation of health disparities for at-risk families by addressing SDOH. Abbreviations: ACEs — Adverse Childhood Experiences SDOH — Social Determinants of Health FRS – Family Resource Survey

INDEX WORDS: Child poverty, Toxic stress, Health effects of poverty and toxic stress, Social determinants of health (SDOH), Adverse childhood experiences (Aces), Health disparities, Health inequities, Behavioral health, Food insecurity, Pediatric clinician’s role, Screening, Intervention, Unmet needs, Missed opportunities, Primary care clinical setting